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Submitted To:
Office of National Coordinator for Health Information Technology
Department of Health and Human Services
Regarding:
American Recovery and Reinvestment Act
State Health Information Exchange Cooperative Agreement Program
Opportunity #EP-HIT-09001
CFDA# 93.719
Every Oklahoman will
benefit from the improved
quality and decreased cost
of health care afforded by
the secure and appropriate
communication of their
health information to all
providers involved in their
care, raising the health
status of individuals and
the entire state population.
– Oklahoma Health
Information Exchange
Trust Vision Statement
Oklahoma’s Revised Strategic Plan
for the
State Health Information Exchange Cooperative
Agreement Program (SHIECAP)
Submitted by:
Oklahoma Health Information Exchange Trust
March 11, 2011
OHIET Revised Strategic Plan Page 1
Table of Contents
Page
1. Strategic Plan
1.1. Oklahoma Approach to Health Information Technology .................................4
1.1.1. History of Health Information Technology in Oklahoma .............................. 4
1.1.2. Vision, Mission and Goals of Oklahoma Health
Information Exchange Trust ...................................................................... 6
1.1.3. Purpose of Oklahoma Health Information Exchange Trust ........................... 9
1.1.4. Operations Plan Elements ........................................................................... 11
1.2. Environmental Scan Outcomes in Oklahoma.................................................. 12
1.2.1. Current and Planned HIOs for Oklahoma .................................................... 12
1.2.1.1. Heartland HealthNet.............................................................................. 13
1.2.1.2. SMRTNET................................................................................................ 13
1.2.1.3. OPHX ...................................................................................................... 13
1.2.1.4. GOCHC.................................................................................................... 14
1.2.1.5. GTHAN.................................................................................................... 14
1.2.1.6. Summary of the Current Gaps in HIE in the State of Oklahoma ........... 14
1.2.2. Broadband.................................................................................................... 14
1.2.3. Levels of Technology Development and EHR Adoption in Oklahoma......... 18
1.2.4. E‐prescribing Readiness and Adoption........................................................ 19
1.2.5. Laboratory Readiness................................................................................... 20
1.2.6. Additional Statewide Readiness .................................................................. 22
1.3. Oklahoma’s Strategy for Stage 1 Meaningful Use .......................................... 23
1.4. Health Information Exchange Coordination Strategies................................... 26
1.5. Domain Area Strategies ................................................................................. 27
1.5.1. Governance ................................................................................................. 27
1.5.1.1. Structure to Achieve Results ................................................................. 27
1.5.1.2. Decision Making Authority .................................................................... 28
1.5.1.3. Set Up and Membership Representation ............................................. 29
OHIET Revised Strategic Plan Page 2
1.5.1.4. Oklahoma Health Information Technology Coordinator ...................... 30
1.5.1.5. Alignment with Nationwide Health Information
Network Governance ........................................................................ 30
1.5.1.6. Alignment with State Medicaid Hit Plan ............................................... 30
1.5.1.7. Standards .............................................................................................. 31
1.5.1.8. Accountability and Transparency ......................................................... 32
1.5.1.9. Continued Opportunities for Improvement .......................................... 32
1.5.2. Finance ........................................................................................................ 32
1.5.2.1. Business Model ......................................................................................... 32
1.5.2.2. Approach to Sustainability ....................................................................... 34
1.5.3. Technical Infrastructure .............................................................................. 34
1.5.3.1. Interoperability ........................................................................................ 34
1.5.3.1.1. Nationwide Health Information Network Connectivity......................... 34
1.5.3.1.2. Standards Adoption ............................................................................... 35
1.5.3.2. Enabling Meaningful Use in Oklahoma..................................................... 35
1.5.3.3. Approach to Technical Architecture: “Network of Networks” Model ..... 35
1.5.3.4. Health Information Technology Components .......................................... 37
1.5.3.4.1. Electronic Health Records ..................................................................... 37
1.5.3.4.2. eMPI....................................................................................................... 37
1.5.3.4.3. Scalability .............................................................................................. 37
1.5.3.4.4. Public Health Technology ...................................................................... 38
1.5.3.4.5. Broadband ............................................................................................. 39
1.5.3.5. Approach to Clinical and Quality Assurance Measures............................ 39
1.5.4. Business and Technical Operations ............................................................. 40
1.5.4.1. Implementation ........................................................................................ 40
1.5.4.2. Project Management ............................................................................... 40
1.5.4.3. Leveraging Existing Health Information Technology
Capacities and Services .......................................................................... 41
1.5.4.4. Communications, Education and Marketing Strategy.............................. 41
OHIET Revised Strategic Plan Page 3
1.5.5. Legal / Policy ............................................................................................... 42
1.5.5.1. Privacy and Security ................................................................................ 43
1.5.5.2. State Laws ............................................................................................... 46
1.5.5.3. Policies and Procedures .......................................................................... 47
1.5.5.4. Trust Agreements .................................................................................... 47
1.5.5.5. Oversight of Information Exchange and Enforcement ........................... 47
2. Operational Plan (under separate cover)
3. Appendices – Strategic and Operational Plans 48
3.1 Project Schedule ............................................................................................ 49
3.2 Legislation, Senate Bill 1373 .......................................................................... 50
3.3 Oklahoma Health Information Exchange Trust Indenture ............................ 58
3.4 Oklahoma Health Information Exchange Trust Bylaws ................................ 78
3.5 Oklahoma Health Information Technology Coordinator Position Description 91
3.6 Governor Henry’s State Designation Letter .................................................. 94
3.7 Position Description of Advisory Board Members......................................... 96
3.8 List of Participants in Oklahoma State Health Information Exchange
Cooperative Agreement Program .............................................................. 104
3.9 Glossary of Acronyms .................................................................................... 107
3.10 Oklahoma Standard Authorization to Use or
Share Protected Health Information (PHI)................................................. 110
3.11 Letters of Endorsement ................................................................................. 112
3.12 Parity Check with PIN .................................................................................... 119
3.13 Governor Henry’s Re‐Designation Letter....................................................... 125
3.14 Biographical Information on OK’s HIT Coordinator ....................................... 126
3.15 Resumes of OHIET Trustees........................................................................... 129
OHIET Revised Strategic Plan Page 4
1. Strategic Plan
1.1. Oklahoma Approach to Health Information Technology
1.1.1. History of Health Information Technology in Oklahoma
For over half a decade, collaborative efforts of public and private entities have
established a strong foundation from which Oklahoma draws support for advancing
Health Information Exchange (HIE) under the State Health Information Exchange
Cooperative Agreement Program (SHIECAP).
In 2004, Oklahoma took an initial step toward development of a state HIE by participating
in the Health Information Security and Privacy Collaborative (HISPC) program. Through
HISPC, a broad base of stakeholders from Oklahoma's health care community, including
providers, payors, government agencies, professional trade organizations and private
consumer advocates, collectively identified barriers and studied how to overcome them
while promoting a secure HIE. This key work culminated in the enactment of the
Oklahoma Health Information Exchange Act, allowing a Standard Authorization Form for
sharing protected health information. The form can support exchange of either paper or
electronic medical records and serves as a valuable education resource for consumers
concerning the scope of exchanges requiring authorization under federal and state
privacy law. The initial HISPC collaborative workgroup continues to exist as a council
pursuant to a 2008 executive order issued by Oklahoma Governor Brad Henry. (This
group is represented in the advisory board of the new Oklahoma Health Information
Exchange Trust (OHIET), the state designated entity (SDE) for Oklahoma’s SHIECAP funds
and activities.)
In 2005, the Secure Medical Records Transfer Network (SMRTNET) became one of
Oklahoma's first operational regional health information organizations (HIO). Since that
time, a number of other exchanges have emerged within the state, including Heartland
HealthNet, Oklahoma Physicians Health Exchange, Greater Oklahoma City Hospital
Council Exchange (GOCHC), and the Greater Tulsa Health Access Network (Greater THAN).
These exchanges have connected healthcare providers from both urban and rural areas,
health systems and public partners for purposes of data exchange.
In 2008, Oklahoma received notice of its selection as one of 12 communities to
participate in the Center for Medicare and Medicaid Services (CMS) Electronic Health
Records (EHR) Demonstration Project. Although CMS cancelled this project in 2009 to
align funding opportunities with those passed under the American Recovery and
Reinvestment Act of 2009 (ARRA), Oklahoma's selection reflected the state's record for
advancing HIE through multi‐stakeholder involvement and readiness for adoption and
exchange using Health Information Technology (HIT).
OHIET Revised Strategic Plan Page 5
Oklahoma’s HIE History at a Glance
Year Event Results
2004 OK participates in HISPC • OK HIE Act
• Standard Authorization Form
2005 SMRTNET (state’s first HIO) became
operational
• Paved way for several other regional HIOs
2008 OK selected for CMS EHR demonstration
project
• Acknowledgment of accomplishments of
HIE in OK
2009 Health Information Infrastructure
Advisory Board (HIIAB) set up by
legislature
• OHCA became hub for state agencies
exchange
2010 Oklahoma Health Information Exchange
Trust (OHIET) set up by legislature
GTHAN receives Beacon Community
grant
• OHIET became SDE for OK SHIECAP and
governance of state HIE
• Major new HIE for NE OK
In 2009, the Oklahoma legislature demonstrated Oklahoma's commitment to HIE
amongst government agencies by enacting legislation that created the Health Information
Infrastructure Advisory Board (HIIAB). The board is comprised of a number of state
agencies involved in various aspects of public health. The legislation directed the board
to assist Oklahoma's Medicaid Agency, OHCA, in developing strategic approaches for
adoption of electronic medical records technologies and HIE. The legislation also directed
OHCA to serve as the hub for exchange amongst state agencies.
Finally, Oklahoma’s 2010 legislative session enacted SB 1373, setting up a new public
trust, the Oklahoma Health Information Exchange Trust (OHIET). OHIET serves as the
organizational structure and state‐designated entity (SDE) for SHIECAP funding and
activities. OHIET is a state‐beneficiary public trust created under legislation expressly
aimed at establishing an entity capable of serving not only as Oklahoma's permanent SDE
during the SHIECAP grant period, but that will also ensure the state meets future
meaningful use requirements and the full advancement of HIE throughout the state.
Working closely with the state’s Regional Extension Center (REC), Beacon Community,
other HIOs, and our broadband initiatives, OHIET will expand existing resources and
leverage new and increasing resources to promote future HIE activities and meet the
goals set by ONCHIT.
OHIET Revised Strategic Plan Page 6
1.1.2. Vision, Mission and Goals of OHIET
Vision Statement:
Every Oklahoman will benefit from the improved quality and decreased cost of healthcare
afforded by the secure and appropriate communication of their health information to all
providers involved in their care, raising the health status of individuals and the entire
state population.
Mission Statement:
OHIET will enable all Oklahoma providers to rapidly locate and access sources of patient
data maintained anywhere in the state, in accordance with all state and federal laws.
OHIET will facilitate electronic access to shared patient data utilizing a single query which
may be submitted either in conjunction with, or separate from, an electronic medical
record.
OHIET will operate in a secure environment and will eventually be self‐sustaining ‐‐ not
relying upon state‐appropriated funds.
OHIET will ensure that key data elements, as required for Meaningful Use and patient
safety, be accessible statewide and nationally, including the Nationwide Health
Information Network (Direct) and will include structured lab data, pharmacy data, and
immunizations from all willing and available providers whom contract with Medicaid
across the state, as relevant for the provider type.
OHIET will work with providers, state agencies, payors and stakeholder organizations to
develop and operate statewide HIE capabilities via a network of networks, which will be
electronically accessible to all participating providers.
OHIET will work with all stakeholders to provide operational oversight1 and to create and
adopt standards, master patient identification protocols, provider indices, record locator
services, and related technical infrastructure to assure statewide access to patient data
regardless of which HIE network houses the patient data.
OHIET will ensure seamless and secure integration and transmission of data throughout
all HIE networks in Oklahoma and into neighboring networks. OHIET will leverage existing
HIE infrastructure, both operational and planned, to close service and care gaps and
facilitate urban, suburban and rural connections for all willing hospitals and providers.
OHIET will advocate for the use of HIE/HIT by all providers and patients throughout the
state, as well as promote legislation and policies that will enhance and enable effective
use of HIE/HIT.
OHIET will assist in the public awareness and education on information, use and merits of
the HIE and HIT systems.
1 Intended to reflect the participatory management created by the Advisory Board, as well as the ”network
of networks” concept where individual networks participating in the state HIE manage their own data and
operations. This also assures that the state won’t usurp operational control of these networks.
OHIET Revised Strategic Plan Page 7
OHIET may either subsidize the expansion of coverage into service gap areas with
financial support for interface development or related infrastructure needs, and/or
contract directly with vendors to address unmet needs, as required. OHIET is not
obligated to support or encourage any single HIE effort, but is intended to act in the best
interest of the providers and patients of Oklahoma. OHIET may provide financial support
for the development of basic needs common to all Oklahoma‐based HIE networks.
OHIET will collaborate and coordinate with other ARRA funded initiatives in the state
including the Regional Extension Center and Beacon Community efforts to leverage
resources, avoid duplication of cost and work efforts, and share best practices.
OHIET Clinical Quality and Performance Improvement Goals include:
Oklahoma is one of the worst‐performing states in healthcare in the nation. The
Commonwealth Fund, both in 2007 and again in 2009, ranked Oklahoma’s overall health
system 50th among the states in the United States. Public health researchers have
observed that Oklahomans born today have a shorter age‐adjusted life expectancy than
their parents. Clear gaps are evident in the performance of the health systems..
Oklahoma believes a strong HIE infrastructure is a key element to alleviate health
disparities in our state and raise the overall health quality. OHIET is collaborating with
the REC, our Beacon Community and the regional HIOs in the state, to align efforts to
meet HIE goals and objectives.
OHIET Revised Strategic Plan Page 8
OHIET Clinical Quality and Performance Improvement Goals
State Objectives
(Qualitative Targets)
Measurable Outcomes
(Quantitative Targets)
Anticipated Health IT
Outputs
(Target Year)
COST-EFFICIENCY Justification: Oklahoma ranks 45th in the nation in terms of re-hospitalization
rates. Improving HIE usage will result in fewer re-hospitalizations
and duplicated services, thereby lowering health care
expenditures by an estimated 5-7%.
10% reduction in overall hospital
readmissions and ED visits regarding
asthma, COPD and CHF
CE1: Reduce preventable
hospitalizations and Emergency
Department visits for Ambulatory
Care and sensitive conditions
5-7% decrease in total aggregate State
Medicaid and Medicare expenditures
CE2: Reduce duplicate and
inappropriate testing, diagnostic
procedures, and specialty referrals
Reduce the number of duplicate lab
tests by 10%; reduce referrals to
specialty care by 10%
CE3: Reduce costs for duplicate
technologies/eMPI/governance and
legal across providers, institutions
and other ARRA efforts
TBD
Advanced HIE
implementation rates and
provider adoption rates
beyond 75% (2015)
QUALITY OF CARE Justification: Connecting underserved populations to HIEs will allow
faster access to other facilities and specialists and support
improvements to transitions of care. Increasing the number of HIE
users leads to better communication and more accurate diagnoses,
thereby improving medication reconciliation and reducing the number
of adverse drug events or medical errors.
QC1: Increase timely access to
specialty care for rural, tribal,
uninsured and other potentially
underserved populations
Decrease patient wait times for initial
specialist opinion to 10 business days
via HIE messaging and e-referrals. (We
are testing this data on a regional
basis.)
QC2: Improve transitions of care and
patient safety by improving the
medication reconciliation process
TBD
Enhanced communication
between healthcare
providers
(2015)
OHIET Revised Strategic Plan Page 9
and accuracy across inpatient
settings and provider offices
POPULATION HEALTH Justification: The Oklahoma State Health Rankings demonstrates how
all the goals tie to health disparities. Increasing statewide vaccination
rates and prevention screening will improve care for those currently
whose needs are currently unmet, thereby reducing health disparities.
In addition, chronic disease management efforts can be focused on
high-risk populations due to improved HIE tools for communication
and epidemiological analysis.
10% increase in the number of
Pneumovax and Influenza vaccinations
10-20% increase in the number of lipid
panels performed
PH1: Increase the number of
patients using preventative services
3-5% increase in the number of
patients having regular mammograms
and PSAs
PH2: Improve public health
outcomes for CHF, DM, smoking
cessation and alcohol usage
5-10% reduction in smoking rates and
alcohol usage. Reduction of 1% in
population aggregate HgA1C for DM.
Decrease CHF admissions by 10%
Evaluation tools that allow
for advanced analytics and
performance feedback
systems (2015)
1.1.3. Purpose of OHIET
OHIET has the following items expressly delineated into the articles of indenture for the
public trust:
a) Establish and maintain a framework for the statewide exchange of health
information, and encourage the widespread adoption and use of EHR systems
among Oklahoma health care providers, hospitals, pharmacies, laboratories,
payors and patients.
b) Promote and facilitate the sharing of health information among health care
providers within Oklahoma and in other states by providing for the transfer of
health information, medical records and other health data in a secure
environment for the benefit of patient care, patient safety, reduction of
duplicate medical tests, reduction of administrative costs and any other
benefits deemed appropriate by the trust.
c) Establish and adopt minimum standards and requirements for the use of
health information and the requirements for participation in trust‐certified
OHIET Revised Strategic Plan Page 10
HIEs for persons or entities including, but not limited to, health care
providers, payors, laboratories, pharmacies and local HIEs.
d) Establish minimum standards for accessing the HIEs certified by the trust to
ensure that the appropriate security and privacy protections apply to health
information, consistent with applicable federal and state standards and laws.
The trust shall have the power to suspend, limit or terminate the right to
participate in certified HIE for non‐compliance or failure to act, with respect
to applicable standards and laws, in the best interests of patients, users of
certified HIE or the public. The trust may seek all remedies allowed by law to
address any violation of the terms of participation in certified HIE or
applicable statutes and regulations.
e) Identify and overcome barriers to the adoption of EHR systems. Efforts may
include assistance with broadband initiatives and researching the rates and
patterns of dissemination and use of EHR systems throughout the state.
Partner closely with the REC and professional organizations to ensure rural
Oklahoma providers, hospitals, laboratories and pharmacies can contribute
and receive data via HIE.
f) Solicit and accept grants, loans, contributions or appropriations from any
public or private source and expend those moneys, through contracts, grants,
loans or agreements, on activities it considers suitable to the performance of
its duties.
g) Determine, charge and collect appropriate fees, charges, costs and expenses
from certified healthcare provider or entity in connection with its contractual
duties.
h) Employ, discharge or contract with staff, including administrative, technical,
expert, professional and legal staff, as is necessary or convenient to carry out
the purposes stated in this Article III (Please see Appendix 3.3, OHIET
Indenture) .
i) To plan, establish, develop, construct, enlarge, remodel, improve, make
alterations, extend, maintain, equip, operate, lease, furnish and regulate
inter‐HIE exchange for the benefit of patients.
j) To construct, install, equip and maintain any hardware, software, technology,
equipment and programs necessary for the interoperability of HIEs certified
by the trust.
k) To construct, equip and maintain any facilities for the development,
maintenance and operation of the interoperability HIEs certified by the trust.
l) To acquire by lease, purchase or otherwise, and to plan, establish, develop,
construct, enlarge, improve, extend, remodel, maintain, equip, operate,
furnish, regulate and administer any and all physical properties (real, personal
or mixed), intellectual properties (copyrights, trademarks, patents, licenses),
rights, privileges, immunities, benefits and any other things of value,
OHIET Revised Strategic Plan Page 11
designated or needed in establishing, maintaining and operating the core
components required for the interconnection of multiple exchanges.
m) To finance, refinance and enter into contracts of purchase, lease‐purchase or
other interest in, or operation and maintenance of, the properties and other
assets listed in paragraphs (e) and (f) above, and revenue thereof, and to
comply with the terms and conditions of any such contracts, leases or other
contracts made in connection with the acquisition, equipping, maintenance
and disposal of any of said properties; and to relinquish, dispose of, rent or
otherwise make provisions for properties owned or controlled by the trust
but no longer needed for trust purposes.
n) To transact business anywhere in the state of Oklahoma to the extent it
benefits the citizens of the beneficiary.
o) To provide funds for the cost of financing, refinancing, acquiring, constructing,
purchasing, equipping, maintaining, leasing, repairing, improving, extending,
enlarging, remodeling, holding, storing, operating and administering the core
components required for the interconnections of HIEs and any or all of the
properties and assets indicated in paragraphs (e) and (f) above needed for
executing and fulfilling the trust purposes as set forth in this instrument and
all other charges, costs and expenses necessarily incurred in connection
therewith and in so doing, to incur indebtedness, either unsecured or secured
by all or any part of the trust estate and its revenues.
p) To expend all funds coming into the hands of the trustees as revenue or
otherwise for the payment of any indebtedness incurred by the trustees for
purposes specified herein, and in the payment of the aforesaid costs and
expenses, and in payment of any other obligation properly chargeable against
the trust estate, and to distribute the residue and remainder of such funds to
the beneficiary upon termination of the trust.
1.1.4. Operations Plan Elements
In the Operations Plan that follows, execution of OHIET strategies are outlined in six key
areas, as follows. Emphasis, in the Operations Plan for the first year is around executing
these elements in pursuit of meeting Stage 1 Meaningful Use in Oklahoma.
1. Develop a process certifying health information organizations to ensure that
every region of the State is served by a high‐quality health information
organization. Areas of focus for this activity will include, but not be limited to,
evaluations of governance, technology, privacy & security policies and capabilities,
and financial stability.
2. Design grant programs that fit the overall state strategy to meet S1MU and
following meaningful use stages.
3. Ensure the plan, development and implementation of shared services and
technologies that are best suited to centralized, statewide implementation, in
support of the network of health information organizations in the State. Areas of
OHIET Revised Strategic Plan Page 12
focus for this activity include a) a state‐wide policy for privacy and security, b) an
electronic master person, provider, or patient index services and/or standards, c)
state agency data services (i.e. immunization registry, vital statistics, etc.) to
support all certified HIOs, d) a process and/or technology to enable state‐wide
reporting of health and healthcare system outcome metrics from the network of
HIO networks, and e) and participation in a health insurance exchange for the
state.
4. Identify and assemble policy and statutory changes needed to support ongoing,
appropriate, and secure health information exchange in Oklahoma and provide
information and support as needed throughout the legislative, executive, or
judicial processes required to achieve the changes.
5. Coordinate activities for Inter‐HIO, Inter‐HIT (i.e., Beacon, Challenge, Benefits
Exchange grants) and Interstate HIE, to ensure the seamless exchange of
appropriate health information for patients receiving care in multiple states or
regions and to streamline efforts and resources expended.
6. Evaluate and monitor the continuing HIE activities throughout the state and
others that may impact our state HIE endeavor.
1.2. Environmental Scan Outcomes for Oklahoma
1.2.1. Current and Planned HIOs for Oklahoma
The environmental scan depicts Oklahoma’s multiple regional HIEs in their varying stages
of development or operation. The regional HIEs are the foundation for the statewide
“network of networks” and are committed to participate in a statewide interoperable
exchange of healthcare data and the attendant enabling activities. Each regional HIE is
described further in this section. EHR adoption rates were higher than expected for
providers eligible for incentive payments. Understanding of EHR functionality by office
staff, however, was shown to be sub‐optimal and an area of needed focus to meet OHIET
objectives.
All HIEs included in this study are focusing on the core elements of the CCD including
demographics, drug allergies, prescription history, coded problems, structured lab data
and the ability to both receive data and transmit data. These HIE have contributed to the
growing set of standards that will be adopted by OHIET.
Areas of focus for both the REC and OHIET include functionality to meet meaningful use in
both e‐prescribing and lab ordering and reporting. OHIET, the REC and the regional HIOs
have incorporated faculties to ensure all providers, hospitals, pharmacies and
laboratories have appropriate information and guidance to enable/select their core EHR
and institutional electronic systems and extending these services to all areas of the state.
OHIET Revised Strategic Plan Page 13
NHIN Direct may be leveraged as an agent to deliver HIE for those providers and hospitals
that choose not to participate in an existing or future network within the OHIET network
of networks.
A summary of each HIE follows.
1.2.1.1. Heartland HealthNet
Heartland HealthNet is owned by the Oklahoma State University Center for Health
Sciences (OSU‐CHS). Its membership is comprised of rural critical access hospitals and
OSU faculty. Heartland HealthNet currently exchanges referral data within its HIE. The
exchange of clinical data is planned for a summer 2010 implementation. Heartland
HealthNet’s original mission to connect four small rural hospitals to a large tertiary
hospital center has grown to include OSU adjunct faculty and clinics.
Heartland HealthNet is based on Covisint’s ExchangeLink product. Cloud applications are
available to bring services into a customized view. ExchangeLink also supports interfaces
to the majority of EHR vendors.
1.2.1.2. Secure Medical Records Transfer Network of Oklahoma (SMRTNET)
SMRTNET is a public non‐profit system of networks including Greater Oklahoma City
Hospital Council GOCHC, Norman Physician Hospital Organization (NPHO), Open Access
Network for all Oklahoma providers, the northeast Oklahoma network, and the Health
Alliance for the Uninsured. SMRTNET has also supplied HIE planning services to the
Greater Tulsa Health Access Network (Greater THAN, a Beacon Community network),
Tulsa Hospital Council, the state’s community health centers, and several other networks
currently in development. Networks using SMRTNET share over $2 million in assets and
harmonize HIE to HIE data exchange through common policy, consensus management,
shared legal documents and shared security measures.
The current shared SMRTNET database includes a master patient index (MPI) of
approximately 4 million patients, 16 million diagnoses, 52 million immunizations/results,
and data provided by over 11,000 providers from all 77 counties in the state of Oklahoma.
SMRTNET is exchanging data across urban, suburban and rural care areas and includes
both hospital and ambulatory data. SMRTNET currently includes structured data for
diagnosis, immunizations, drug allergies, medications, laboratory results and incorporates
e‐prescribing through its portal. Thousands of physicians, practitioners and nurses across
the state are currently and actively using SMRTNET to provide safe and high quality
patient care.
SMRTNET evolved as part of an Agency for Healthcare Research and Quality (AHRQ) effort
to develop working model HIEs for the country. The outcome is successfully providing
networking services that include private providers, hospitals, Native American tribes,
state agencies, universities and mental health facilities. The cost to develop this capacity
has exceeded $4 million over a five‐year period. Currently, there are 46 entities
exchanging data across Oklahoma; 23 in the rural areas and 23 in urban areas.
OHIET Revised Strategic Plan Page 14
1.2.1.3. Oklahoma Physicians Health Exchange (OPHX)
Norman Physician Hospital Organization (NPHO) is operating an integrated clinical
network using a community EHR. NPHO selected eClinicalWorks as the platform to create
a community electronic record for patients. Electronic Health Exchange (eEHX) provides
interoperability between the NPHO physicians, ambulatory centers and hospitals
connecting their EHRs. Additional data sources and services have been added to the
OPHX by joining SMRTNET as an affiliate. Approximately 150 providers in the Norman
and Purcell areas participate in the OPHX effort. OPHX currently allows the secure
passage of a CCD, electronic messaging, referrals, laboratory orders, results and
prescription history.
1.2.1.4. Greater Oklahoma City Hospital Council Exchange (GOCHC)
GOCHC started with nine hospitals to form a regional HIE to improve the efficiency and
overall coordination of care to all patients. GOCHC began its initiative three years ago
with a special focus on caring for the uninsured presenting in emergency departments.
The focus has expanded well beyond the ER to include all providers, hospitals and data
contributors in the greater Oklahoma City region. The exchange has grown to 30 hospital
members across the state and the Health Alliance for the Uninsured clinics. The GOCHC
exchange is a SMRTNET affiliate with a separate governing body.
1.2.1.5. Greater Tulsa Health Access Network (GTHAN)
GTHAN exists to improve health outcomes for the citizens of the greater Tulsa area. The
project has received a $12 million Beacon Community grant from ONC. The HIE will
provide access to 1,600 providers and improve the care coordination and disease
outcomes of their patients. The group has selected Covisint ExchangeLink to accomplish
the task and will provide a significant resource for NE Oklahoma, rural, urban and
suburban hospitals, providers, laboratories and pharmacies with best practice for EHR
adoption to facilitate the expansion of HIE. GTHAN will also provide additional insight as
a newly established HIE and collaborative community effort for technology, standards and
best practices for HIE to OHIET.
1.2.1.6. Summary of the Current Gaps in HIE in the State of Oklahoma
With a six year maturation of HIEs in the state, Oklahoma has a very good start on
coverage. Major HIOs are running and exchanging data in most populated parts of the
state. These facilities will be bolstered and improved by the additional funds afforded
them by ARRA. Elements of Stage 1 Meaningful Use will be met by all eligible providers
through existing and planned HIOs and, where broadband coverage is limited, by ASP
models and other functionality made available by SMRTNET. We anticipate no difficulty
in meeting Stage 1 HIE access requirements in FY2011.
OHIET Revised Strategic Plan Page 15
1.2.2. Broadband
The disparity in broadband infrastructure between the urban and rural areas of Oklahoma
is problematic, particularly in areas where bandwidth is unavailable or unaffordable.
Oklahoma has received three grants, through ARRA, that make great headway on bringing
broadband access throughout the state.
The Oklahoma Community Access Network (OCAN) received $74 million to build more
than 1,000 miles of fiber‐optic cable along 13 segments of interstates and highways in 33
counties.
Exhibit 1 – Proposed Broadband Backbone for the State of Oklahoma
An excerpt from the OCAN Executive Summary:
The Oklahoma Community Access Network (OCAN) proposal presents an unprecedented
opportunity for Oklahoma to meet the demands of life in the 21st century. Easy and
reliable access to technology for Oklahomans to travel along the information highway is
as essential in today’s world as the construction of rail was to Oklahoma’s settlement.
OHIET Revised Strategic Plan Page 16
Oklahoma is the 20th largest state in the nation with a population of just over 3.5 million
people. Sixty percent of the population resides in the two metropolitan areas of Tulsa and
Oklahoma City. The remaining forty percent are spread across the state in communities
ranging in size from a few hundred people to 25,000.
The action plan for Oklahoma’s future is focused squarely on today’s knowledge‐based
economy requiring highly educated, technology proficient Oklahomans who can access
and use investments in technology infrastructure to their benefit. With Oklahoma’s
significant rural base across a geographically large area, access to broadband is the key to
growth and prosperity. Creating access to basic services through technology means
Oklahomans in the most remote areas of the state can be in contact with public service
providers, can access distant learning and health care services and can communicate with
their government and one another more readily.
OCAN’s proposal seeks to build 1, 005 miles of new middle‐mile fiber infrastructure to
connect 32 anchor institutions in underserved and unserved areas of the state where a
broadband penetration rate barely reaches 25% in some cases. The fiber route selected
touches 35 of Oklahoma’s 77 counties, approximately 89% of the state’s population, and
is on state highway right‐of‐way. Within five miles of the proposed fiber build are 1,096
schools, libraries, medical or health care providers, public safety entities, community
colleges, institutions of higher education, along with other community support
organizations and government facilities.
OCAN’s middle‐mile infrastructure will support a variety of last‐mile projects of particular
interest to private sector providers who along with local, state and tribal entities have
voiced their support for the project’s goals. OCAN’s impact, as additional fiber
connections are constructed, will mean unprecedented access to essential services for
rural Oklahomans. A number of state agencies own, manage and maintain
telecommunications infrastructures, both wireless and wireline to include the Oklahoma
State Regents for Higher Education, Office of State Finance, Oklahoma Department of
Transportation, and the Oklahoma Turnpike Authority who have worked for over a year
to provide a foundation for OCAN’S application.
OCAN’s grant request is $73,998,268 with a proposed cash and in‐kind match of 20.4%.
OCAN’s proposal will leverage existing state assets with federal funding to address the
great disparity in broadband access between urban and rural areas of Oklahoma.
OCAN principals have more than thirty decades of experience developing and sustaining
public/private partnerships with broadband and telecommunications providers. It is the
goal of the OCAN proposal to expand its partnerships with the commercial provider
community to provide broadband to all areas of the state in the most cost‐effective and
efficient manner possible. In addition to the private providers mentioned specifically in
the application, other partnerships are being pursued and will continue following the
submission of this application. It is anticipated that 863 jobs will be created as a result of
this project.
OHIET Revised Strategic Plan Page 17
Community Anchor Institutions
Miles from Current
Anchor Institution City Backbone Capacity
Community Colleges
Ardmore Higher Education Center Ardmore 6.5 2xFE (200)
Carl Albert State College Poteau 0.2 2xDS3 (90)
Carl Albert State College Sallisaw 0.1 DS3 (45)
Cheyenne and Arapaho Tribal College Weatherford 1
Conners College Warner 2 DS3 (45)
Comanche Nation Tribal College Lawton 1 2xT1 (3)
Eastern Oklahoma State College McAlester 2 DS3 (45)
Eastern Oklahoma State College* Wilburton 0 DS3 (45)
Northern Oklahoma College Enid 2 DS3 (45)
Redlands Community College El Reno 0.7 FE (100)
Seminole State College Seminole 2 DS3 (45)
Western Oklahoma State College Altus 0 DS3 (45)
Health Care/Hospitals
Atoka Memorial Hospital Atoka
Mary Hurley Hospital Coalgate
Choctaw Hospital Hugo
Lawton Indian Hospital Lawton 0
Seiling Municipal Hospital Seiling
Jefferson County Hospital Waurika
Woodward Hospital Woodward
Libraries
Duncan Public Library Duncan 0 1.54 Mbps
Public Safety
DPS ‐ Highway Patrol Troop HQ Durant 0 T1 (1.5)
DPS ‐ Highway Patrol Troop HQ Enid 0 T1 (1.5)
CLEET Ada
Universities
Cameron University Duncan
Cameron University* Lawton
East Central University Ada
Northwestern OSU Enid
Northwestern OSU Woodward
Southeastern OSU* Durant
Southeastern OSU ‐ McCurtain Co. Idabel
Southwestern OSU Sayre
Southwestern OSU* Weatherford
OHIET Revised Strategic Plan Page 18
Additionally, Oklahoma Communication Systems, Inc. (parent company, TDS
Telecommunications Corp.) received $3.5 million from the U.S. Department of
Agriculture, matched by about $1.2 million in private money. The project brings high‐speed
Internet service to residents and businesses near Inola, Bristow, Fletcher and Cyril.
Finally, Pine Telephone Co. received about $9.7 million from the USDA to offer 3G
universal mobile broadband service in Coal, Latimer, Le Flore and Pittsburg counties
within the Choctaw Nation.
OHIET is in contact with the OCAN team and we will work in concert to ensure alignment
of goals and plans. We do not anticipate broadband limitations to impact ability to meet
Stage 1 Meaningful Use or future OHIET goals. We believe the OCAN and other
broadband plans greatly enhance the HIE plans for Oklahoma.
1.2.3. Levels of Technology Development and EHR Adoption in Oklahoma
Oklahoma’s providers and hospitals are in various stages of automation, with larger, more
urban organizations generally having partially or fully implemented EHRs versus smaller
and rural practices and hospitals including Critical Access Hospitals, on the slower end of
adoption. Mid‐sized organizations, such as Federally Qualified Health Centers
(FQHCs)/Rural Health Clinics (RHCs) and multi‐provider groups, fall somewhere in the
middle when using, adopting and implementing EHR/EMR solutions.
Exhibit 2 shows the results of overall EHR adoption among eligible provider groups for
incentive payments.
Exhibit 2 ­Percentage
of Providers Reporting EHR/EMR by Group
Indian Health
Service (IHS)
providers have the
highest rate of
current EHR
adoption of any
provider category
in Oklahoma. IHS
has access to EHR
capabilities through
the federal
Resource and
Patient Management System (RPMS). Of the 475 IHS health professionals that
responded, 88% indicated they had an EHR/EMR.
OHIET Revised Strategic Plan Page 19
Only 23% of the rural hospitals surveyed indicated they had an EHR/EMR. 54% of urban
hospitals surveyed
have an existing
EMR. Of all
surveyed, only 64%
of hospitals
reported having
access to
broadband services
(36% reported no
broadband access).
Exhibit 3 ­Indian
Health Service and Tribal Providers
Regarding Oklahoma’s Community Health Center (CHC) organizations, 15 of 17 (88%)
have implemented an ambulatory EHR; most CHCs currently have broadband service.
The REC, regional HIOs and OHIET are working together to identify and target most needy
areas, set up faculties for guidance and information provision on EHR/EMR, and engineer
a set of solutions to meet Stage 1 Meaningful Use.
1.2.4. E‐prescribing Readiness and Adoption
Electronic prescribing capabilities are growing in Oklahoma. In 2009, according to
SureScripts, 18% of all physicians have systems that allow the routing of prescriptions
electronically and 10% of all prescriptions were routed electronically. Only 3% of patient
visits, however, resulted in a medication history request.
The Oklahoma Pharmacy Association reports that 85‐90% of all pharmacies are currently
capable of accepting electronic prescriptions (corporate pharmacies at 100% while
independent pharmacies are at 75‐80% including rural areas).
OHIET and other state leaders will spearhead activities to drive adoption of e‐prescribing
by all pharmacies statewide.
OHIET has a program to partner with small pharmacies, which may find the start‐up costs
of electronic prescribing prohibitive, that offers a financial incentive program to assist
them with these costs. To drive EHR adoption and create demand for e‐prescribing
capability at the pharmacy level, a collaboration between the Oklahoma Pharmacy
Association, the REC, and State Medical Associations to assist and guide rural providers on
benefits and best practices of EHR. In addition, OHCA (the state Medicaid agency) has
aligned with SureScripts to include in their contracts a requirement that state Medicaid
participating pharmacies participate in electronic prescribing.
OHIET Revised Strategic Plan Page 20
OHIET recognizes that a successful statewide HIE requires complete pharmacy electronic
prescription data and that this is a key component for helping all providers and hospitals
qualify under Meaningful Use. OHIET also recognizes the challenges for electronic
prescribing as they relate to controlled substances and intends to promote the
development of protocols to allow this functionality in a seamless fashion for providers
and pharmacies as these issues are further clarified.
1.2.5. Laboratory Readiness
Another key component of meeting Meaningful Use criteria for providers and hospitals is
the ability to transmit structured lab data. OHIET intends to certify standards by which
laboratory data can pass from HIE to HIE via LOINC coding. Ultimately, success of this
program is contingent upon the thorough adoption of EHR and, as stated elsewhere in
this plan, we will partner with the REC and professional and hospital associations to
ensure the infrastructure and services are adequate to meet Meaningful Use by all
eligible providers. The initial 2011 goal for OHIET will be for laboratory result reporting
with consideration for the submission of laboratory orders in 2013 and beyond.
The analysis of Oklahoma’s current laboratory electronic result reporting is taken from
data collected by SoonerCare. The top 19 paid laboratories by SoonerCare represent 82%
of all SoonerCare dollars paid to labs in 2010. The list follows.
1 DIAGNOSTIC LABORATORY OF OKLAHOMA OKLAHOMA CITY OK 73108 $7,563,764.57
2 OK STATE DEPT OF HLTH PUBLIC HLTH LAB OKLAHOMA CITY OK 73117 $4,322,648.51
3 REGIONAL MED LAB TULSA OK 74114 $3,462,095.35
4 CLINICAL PATHOLOGY LAB AUSTIN TX 78754 $1,582,117.03
5 NATIONAL HLTH LAB DALLAS TX 75230 $1,529,819.42
6 QUEST DIAGNOSTICS CLINICAL LABORATORY
INC
SJ CAPISTRANO CA 92675 $1,318,773.44
7 SAINT FRANCIS OUTREACH SERVICES LLC TULSA OK 74136 $1,066,615.57
8 AMERITOX, LTD MIDLAND TX 79705 $844,472.87
9 PACIFIC TOXICOLOGY LABORATORIES CHATSWORTH CA 91311 $829,815.66
10 QUEST DIAGNOSTICS CLINICAL LABORATORY
INC
IRVING TX 75063 $825,186.80
OHIET Revised Strategic Plan Page 21
11 OUHSC GENETICS LAB OKLAHOMA CITY OK 73104 $645,658.89
12 GENZYME GENETICS SANTA FE NM 87505 $560,186.32
13 GENZYME GENETICS WESTBOROUGH MA 01581 $522,369.12
14 LABORATORY CORPORATION OF AMERICA SAN ANTONIO TX 78213 $504,770.25
15 HEARTLAND PATHOLOGY CONSULTANTS PC EDMOND OK 73034 $430,464.78
16 WINDSOR PARK MEDICAL CLINIC OKLAHOMA CITY OK 73107 $395,238.59
17 MEDICAL DIAGNOSTICS LABORATORIES LLC HAMILTON NJ 08690 $365,380.04
18 BIO REFERENCE LABORATORIES INC ELMWOOD PARK NJ 07407 $355,268.83
19 DIAGNOSTIC PATHOLOGY SERVICES PC OKLAHOMA CITY OK 73112 $344,373.84
$27,469,019.88
OHIET is in the process of confirming the following set of assumptions:
1. This is representative of the pay portions to labs from all major payors in our
state.
2. The 19 labs listed have electronic results reporting capabilities.
3. The remaining 18 to 20% of labs registered in the state are likely draw stations
and small laboratories that have access to electronic resulting via their selected
reference laboratories.
OHIET recognizes the gap in laboratory reporting will be primarily via rural hospital
laboratories including critical access hospitals. The REC and EHR adoption is intended to
help close this gap as well as close partnership with reference laboratories to expend
their electronic/technologic infrastructure to comply with Meaningful Use for all
providers within the state.
OHCA currently requires all laboratories, under contract with their organization, comply
with OHIET and HL7 laboratory reporting standards. It is the intention of OHIET to
partner with private payors, as well, to facilitate the same actions in their contracts with
laboratories.
OHIET Revised Strategic Plan Page 22
1.2.6. Additional Statewide Readiness
OHIET believes EMPI services will be critical to the success of HIE utilization, adoption and
‘network to network’ connections. OHIET is currently working on the feasibility of
providing a statewide EMPI to regional HIEs .
Provider directories present another challenge for Oklahoma as a primarily rural state.
OHIET is presently working on the feasibility of partnering with state HIOs to maintain an
updated and cohesive provider directory. This is a pathway to ensure adequate
electronic exchange, referrals, reporting and messaging to facilitate the highest quality
and the safest patient care.
OHIET has established a working group to define the minimum requirements of a CCD for
HIE and to develop protocols for ‘network of networks’ sharing in order to create
consolidated views for providers and avoid the need for multiple HIE connections.
OHIET is setting up collaborative teams with payor organizations within the state. Key
outcomes of this association are the active participation in the statewide HIE and the
preparation for 2013 and beyond for requirements for electronic eligibility checking and
prior approvals.
OHIET is considering record locator services, credentialing services, public health reporting
services, immunization reporting and consent management services as areas with
potential for leveraged services across the state, overall healthcare cost reduction and as
revenue sources for OHIET.
Other platforms, established by our two state university medical programs and large
hospitals, provide springboards for OHIET. Oklahoma benefits from a well developed set
of telemedicine networks. These networks are operational and provide specialty care to
rural and underserved areas. This infrastructure provides a pathway to further the goals
of OHIET and meet Meaningful Use.
OHIET Revised Strategic Plan Page 23
1.3. Oklahoma’s Strategy for Stage 1 Meaningful Use
Element: E­prescribing
available to all eligible providers
Gap Recognized Strategy Actions Actors
1. There are approx 25%
pharmacies in the state that do
not have e-prescribing
faculties.
2. Rural pharmacies not on board
because they do not have the
‘market pull’ by local providers;
they see no need to undergo
the expense
• Determine areas of greatest need
• Reduce capital requirements
• Create demand from providers to
drive e-prescribing capabilities at
the pharmacy-level
• Create demand from payors at the
pharmacy-level
• Team with small pharmacies and offer financial incentive
programs to assist with start up costs
• Train local providers on benefits of e-prescribing and on
alternatives, i.e., internet prescribing and the advantages to
the end users (patients)
• Develop curriculum to educate end users, providers and
pharmacies
• OHCA and SureScripts have contract req’s for Medicaid
participating pharma’s to provide e-prescribing – leverage
this and encourage other payors to participate similarly
• OHIET/OPA/REC/OSMA
• OHIET/OPA/REC/OSMA
• OHCA/SureScripts/Payor
s
Element: Receipt of structured lab results available to all eligible providers
Gap Recognized Strategy Actions Actors
1. The large labs are in
compliance. For the smaller
labs, especially those
associated with rural providers,
it is unknown.
2. Rewards for MU are not as
apparent for labs
• Focus on laboratory result
reporting first; confirm
capabilities of large labs and
those receiving payment from
largest payors in OK
• Provide incentives to labs
• Demonstrate benefits
• Form team with labs to understand landscape and areas
requiring most intervention
• Create education/awareness campaign with key benefits for
labs and stakeholders
• OHCA requires labs under contract to comply with OHIET
and HL7 lab reporting standards; work with private payors
to develop same
• OHIET/Labs/Payors
• OHIET/REC/HIOs
• OHIET/OHCA/Payors
OHIET Revised Strategic Plan Page 24
Element: Sharing patient care summaries across unaffiliated organizations available to all eligible providers
Gap Recognized Strategy Actions Actors
1. Sharing patient care summaries
will require HIE connectivity to
hospitals and EP’s. Less than
5% of EP’s are live with HIE.
2. HIE Networks will need to share
and combine CCD’s to EP’s on
other HIE networks.
3. EMPI and Provider Registries
will be a rate limiting factor of
cross connections
4. HIPAA and HITECH
Implications of internetwork
connections.
• OHIET will endorse a network of
networks and will support the
existing and new HIE networks
connections to EP’s
• OHIET will collaborate with the
REC and EP’s and MU funding to
support their HIE connectivity
• OHIET will help establish
standards for network to network
connectivity and security
protocols and messaging
protocols consistent with Direct.
• OHIET will work with existing
networks, new networks and
potentially create services for
EMPI and Provider Registries for
the State
• Exploration of DURSA (sp) and
current state HIE legal policies
• Incentive programs for HIE’s and EP’s in areas of low
penetration of HIE. Particularly rural areas.
• Collaboration between the REC and HIE networks to do
support and offerings of HIE with EHR to EP’s.
• Education to EP’s and marketing to EP’s of the benefits and
use case of HIE.
• Establish inter-network HIE connection standards for
security and privacy.
• Assess current EMPI and provider directory services live in
the state as well as proposed solutions to ensure the
success of a network of networks model. Awareness that
OHIET may have to create an add on service to parallel the
network of networks.
• Exploration of current legal and governance agreements,
DURSA and develop a strategy to protect EP’s who have
contributed data to HIE in case of a data breach or end user
misuse of HIE data.
• OHIET
• REC
• Agencies
• Existing Networks
• New Networks
• EP’s
• Medical Associations
OHIET Revised Strategic Plan Page 25
Element: Ensuring broadband access availability
Gap Recognized Strategy Actions Actors
1. 36% hospitals report no access
to broadband
2. Disparity of access to
broadband between rural and
urban parts of state
• Align project with ~$90M ARRA
funds for state broadband
initiatives
• Provide awareness and guidance
to providers/pharma/labs on
EHR/HIE
• Enable work-arounds to areas
without broadband access
• Work with OCAN and others to dovetail technology req’ts
and goals for access throughout the state
• Create consultancy, communications, education to assist
rural constituents
• Team with vendors to create array of solutions for rural
providers
• OHIET/OCAN/OSU/Sec’y
of State
• OHIET/REC/HIOs
• OHIET/Vendor
community
Element: Promoting effective use by all eligible providers
Gap Recognized Strategy Actions Actors
1. 23% of rural and 54% of urban
hospitals have EMR
2. 47% of non-hospital
professionals have EHR
• Create ‘pull’ by providers
• Provide help, guidance and
education to direct users of the
HIE and the end users of
healthcare
• Ensure compliance with state
and fed req’ts that result in
better health outcomes for the
state
• Establish valuable products and services that will be
standardized centrally and made available through local
HIOs: vital stat’s; eMPI; immunization registries, etc.
• Provide continuing incentives for providing by working
with policies and legislation that promote HIE and better
quality health outcomes for the state
• Team with REC, Beacon, universities and others to
provide survey, analysis, education, guidance, etc. to
providers
• Set up clear governance and policies and avenues for
providers to achieve S1 MU and other req’ts
• OHIET/HIOs/vendors
• OHIET/REC/HIOs/Univ/Trainers
• OHIET/REC/legislators
OHIET Revised Strategic Plan Page 26
1.4. Health Information Exchange Coordination Strategies
Coordination of strategies is hardwired with the Oklahoma authority responsible for
Medicaid.
The Oklahoma Health Care Authority (OHCA) is the state’s Medicaid agency and they
were the State Designated Entity (SDE) in the SHIECAP proposal process (prior to OHIET’s
establishment in the 2010 state legislative session) . OHCA has contributed many
resources to the SHIECAP effort from the response to the ARRA FOA to the continued
work in domain areas determining, documenting and implementing the strategic and
operational approaches to a statewide HIE. In parallel process, OHCA staff have authored
and received approval on the State Medicaid HIT Plan (SMHP). This set up has ensured a
dovetailing of strategies between these efforts.
Collaboration will be preserved between OHIET and OHCA in that John Calabro, the
former OHCA Chief Information Officer who co‐chaired the Statewide Oversight
Committee for SHIECAP, was appointed by Governor Henry of Oklahoma as the state’s
first permanent Health Information Technology Coordinator. Mr. Calabro led an effort
that focused on inclusiveness and collaboration of key stakeholders and ensured plans
were coordinated with concurrent activities of HIIAB, Oklahoma’s REC, our Beacon
Community grantee, OKHISPC and others.
Regarding outreach to educate providers on the Medicaid EHR Incentive Program, the
SHIECAP oversight work group coordinated with professional associations such as the
Oklahoma Medical Association, Oklahoma Osteopathic Association, Oklahoma Hospital
Association, Oklahoma Primary Care Association the FQHCs and RHCs, and the REC
through operational provider workshops and quarterly meetings.
Medicare Coordination Along With Other Federal Programs
OHIET and the HIIAB are collaborating to attain widespread use of HIE by healthcare
providers. Through partnerships with the REC, Beacon Community and professional and
hospital organizations, OHIET will align incentives and drive adoption of EHR along with
CMS, Medicaid and other federal programs.
The OHIET ‘network of networks’ will result in an effective statewide HIE that will allow
healthcare providers to exchange clinical information through their local HIEs, such as
medication histories and laboratory results, electronic prescription history and medical
summaries via a CCD at the point‐of‐care, and make better informed decisions with their
patients. These plans will promote and support the effort of eligible professionals who
wish to achieve Meaningful Use.
The planned OHIET ‘network of networks’ will also outline Oklahoma’s current and future
strategies to leverage existing EHR capacity, investment and broad stakeholder
commitment to advance the HIE goals in Oklahoma.
As indicated earlier in the Strategic Plan, the EHR incentive payments for Meaningful Use
are a cornerstone of the Oklahoma HIE initiative and, supporting the ability of Medicare
providers to participate in the Oklahoma EHR Incentives Program is a key objective.
Oklahoma’s environmental scan and results of statewide HIE planning efforts have
OHIET Revised Strategic Plan Page 27
indicated that the inclusion of Medicare data, along with other federal programs in
statewide and interstate HIE, will be critical to the widespread use and sustainability of
HIE in the state.
OHIET will continue to request its federal partners make this data available so that
Oklahoma providers can use the data and achieve Meaningful Use. OHIET is willing to
work with Medicare, IHS, Department of Defense, Veterans Administration, and other
federal programs to create a workable data exchange.
1.5. Domain Area Strategies
1.5.1. Governance
1.5.1.1. Structure to Achieve Results
The Oklahoma Legislature passed Senate Bill 1373 (Appendix 3.2), which Governor Brad
Henry signed into law on June 10, 2010. This legislation expressly approves the creation
of a state‐beneficiary public trust named the Oklahoma Health Information Exchange
Trust (OHIET). The trust has a governing board of seven trustees appointed by state
officials as follows: three by the Governor; two by the Senate; and two by the House of
Representatives. (Trustees are indentified in Exhibit 4.) OHIET is Oklahoma's state
designated entity (SDE) to facilitate and expand the electronic movement and use of
health information among organizations within Oklahoma and to ensure the goals of
SHIECAP station behalf of Oklahoma. An Advisory Board, consisting of representatives
from 18 to 25 organizations, will provide input and support to the board of trustees.
(Exhibit 5, following.)
OHIET recognizes that core infrastructure must be obtained via EHR’s for eligible
providers, hospitals, laboratories and pharmacies in order to facilitate HIE and Meaningful
Use criteria for the state. As previously mentioned in this plan, OHIET intends to promote
the installation and adoption of EHR technology through partnerships with the REC, the
regional HIOs, the university systems and others to provide training, guidance,
consultation and information.
OHIET will assure the development of statewide HIE standards based upon consensus of
local and regional HIOs. In addition, standards will be inclusive of criteria for laboratory
reporting, electronic prescribing and CCD receipt, generation, transfer and re‐generation .
OHIET will monitor compliance with these standards. OHIET will disseminate best
practices, help to ensure understanding of HIE and its policies and work to promote and
sustain electronic HIE within Oklahoma.
OHIET will ensure there are a clear strategic plan and a shared vision for the development
of the statewide collaboration (short‐term and long‐term) and a fair representation of
networks in the statewide governing body – in keeping with the ”network of networks”
model.
OHIET Revised Strategic Plan Page 28
Oklahoma’s Health Information Technology Coordinator also serves as the Executive
Director of OHIET. The State HIT Coordinator, Mr. John Calabro, was appointed by the
Governor Henry. Mr. Calabro sets the charter for the organization as decreed by the
trustees, oversees the daily operations of OHIET, and serves as the public face of the
organization. Mr. Calabro is in process of evaluating additional supporting staff;
budgeted are a Chief Operating Officer, charged with top level management and daily
outcomes in all domain areas, a business analyst to provide data collation, synthesis and
analysis, and executive support. Each domain area is additionally supported by Advisory
Board task forces and by paid industry experts. The Executive Director is an ex‐officio
member of the board of trustees without voting privilege.
Exhibit 4, OHIET Board of Trustees
Trustee Appointer and Term
Robert H. Roswell, MD,
Board Chairman
Gov. Henry
July 31, 2014
Jenny Alexopulos, DO,
Board Vice Chair & Secretary
Rep. Benge
July 31, 2013
Samuel T. Guild
Board Treasurer
Sen. Coffee
July 31, 2012
Julie Cox-Kain Gov. Henry
July 15, 2015
Craig W. Jones Rep. Benge
July 31, 2015
David Kendrick, MD
Sen. Coffee
July 31, 2015
Brian Yeaman, MD
Gov. Henry
July 31, 2011
1.5.1.2. Decision Making Authority
All powers granted to OHIET under the Oklahoma Public Trust Act and other applicable
local, state and federal laws will be exercised by and under the authority of the trustees.
Additionally, the property, business and affairs of OHIET will be managed under the
direction of the trustees in a manner consistent with the trust indenture (Appendix 3.3)
and the bylaws of the trust (Appendix 3.4).
The number of trustees will be seven (7) as prescribed in Oklahoma law. The conduct of
the trust, including specifics of trustee terms, voting requirements, meeting procedures
and so forth are prescribed by the trust indenture.
OHIET will have an Advisory Board to provide representation of major constituencies
served and to assist in the activities of the trust (Exhibit 5). Recommendations from the
Advisory Board will be presented as an agenda item at a duly called meeting. The
OHIET Revised Strategic Plan Page 29
trustees will give deference to and due consideration of the recommendations of the
Advisory Board. The Advisory Board also will perform such other functions as may be
directed by the trustees in connection with or in furtherance of OHIET.
Subject to the approval of the trustees, the Advisory Board will be entitled to establish
rules, regulations, policies and procedures relating to its operation, and standing and ad
hoc committees and workgroups, in furtherance of its functions.
1.5.1.3. Set Up and Membership Representation
OHIET trustees will have a working knowledge of HIE and background in health care.
The OHIET Advisory Board provides broad stakeholder representation to the organization
and will be composed of not fewer than 17 nor more than 25 persons including, at a
minimum, one representative from each of the following:
Exhibit 5 ­Advisory
Board Member Organizations
1. Oklahoma Health Care Authority [Medicaid], Lynn Puckett, Director Contract Services
2. Oklahoma State Department of Health [Public Health], Rebecca Moore
3. Oklahoma Department of Mental Health and Substance Abuse Services, Terri White, OK Sec’y of
Health
4. University of Oklahoma Health Sciences Center, Kevin Elledge, ED of Ops
5. Oklahoma State University Center for Health Sciences, Dr. James Hess, COO
6. A nominee of the Indian Health Service Office responsible for Oklahoma, Dr. Farris, CMO
7. A representative of Tribal interests, Mitch Thornbrugh, Cherokee Nation
8. Oklahoma Hospital Association, Rick Snyder, COO
9. Oklahoma Osteopathic Association, Dennis Carter, DO
10. Oklahoma Pharmacy Association, Jim Spoon
11. Oklahoma State Medical Association, Dr. Kent T. King
12. Oklahoma State Chamber of Commerce, Matt Robison, VP Small Business & Workforce
Development
13. Security and privacy representative nominated by the Oklahoma Health Information Security and
Privacy Council, Robn Green, OSDH and Vice Chair of OKHISPC
14. A HIE representative as nominated by the OHIET Board, Joseph Walker, Greater THAN
15. A consumer appointed by the Governor, pending
16. A nominee of the Oklahoma Regional Extension Center steering committee, Jonathan Kolarik,
RN, Director of HIT
17. Oklahoma Association of Health Plans, Bill Hancock, VP & GM, CommunityCare Managed Health
Plan
18. Representative of Oklahoma rural providers, Val Schott, Oklahoma State University
19. A second HIE representative as nominated by the OHIET Board, Mark Jones, SMRTNET
Representation from up to six additional organizations
OHIET Revised Strategic Plan Page 30
The trustee board may add up to eight additional memberships to the Advisory Board,
from what is described in the trust indenture, as need for additional expertise and
representation becomes evident. One representative of rural providers and one
additional representative of HIE expertise have been added to the original 17 named in
the indenture.
1.5.1.4. Oklahoma HIT Coordinator
The Oklahoma HIT Coordinator (HITC) exists to provide leadership, direction,
management and coordination of HIT strategy for the state of Oklahoma, which includes
the implementation of federal and state requirements for HIT and HIE efforts. The HITC
works cooperatively with multiple stakeholders, including healthcare providers, health
plans, health profession schools, consumers, technology vendors, public health agencies
and healthcare purchasers to identify existing resources, needs, commonalities of interest
and project priority. Additionally, the Oklahoma HITC manages the plan that prescribes
activities necessary to facilitate and expand the electronic movement and use of health
information among organizations consistent with both state and federal HIT strategic
plans.
Oklahoma’s HITC also serves as the Executive Director of OHIET and he must carry out the
responsibilities of this position along with the other duties of HITC. (Appendix 3.5 –
Oklahoma HIT Coordinator Position Description used to guide the selection team in the
process of identifying and choosing the office holder.) John Calabro, former CIO of OHCA,
was selected and appointed by Governor Brad Henry as Oklahoma’s first permanent HIT
Coordinator. Mr. Calabro took office on December 1, 2010.
1.5.1.5. Alignment with Nationwide Health Information Network (NHIN) Governance
OHIET‘s governance model is designed to be compatible with emerging NHIN governance
principles and functions. A pathway to Stage 1 Meaningful Use compliance is OHIET
becoming the certifying authority of HIE in Oklahoma. Alignment with NHIN governance
is designed as part of this certification process. In further compliance with developing
policies and procedures from NHIN and ONCHIT, OHIET and our partners have planned
curriculum and guidance to assist providers with both. Should entities fall outside of the
OHIET network of networks, alignment directly with NHIN is Oklahoma’s strategy for
Stage 1 Meaningful Use.
1.5.1.6. Alignment with State Medicaid Hit Plan (SMHP)
This Strategic Plan, as well as the Operational Plan, under separate cover, are written in
coordination with the initiatives set forth on the SMHP by the Medicaid agency, OHCA.
The OHCA Chief Information Officer, Mr. John Calabro, (Mr. Calabro is now the appointed
OHIET Revised Strategic Plan Page 31
State HIT Coordinator for Oklahoma) co‐chaired the Statewide Oversight Committee for
the SHIECAP, and OHCA staff members participate on each of the domain area
workgroups to ensure coordination of planning efforts. Emphasis is placed on
collaboration of stakeholders and coordination of activities. This plan and the operational
plan were developed for OHIET, by representatives from the Health Information and
Infrastructure Advisory Board, Oklahoma’s Regional Extension Center, Beacon grant
awardee, the Oklahoma Regional Extension Center, and key stakeholders throughout the
state of Oklahoma. (A full list can be seen in Appendix 3.8).
Outreach to educate providers on the Medicaid EHR Incentive Program was coordinated
with professional associations such as the Oklahoma Medical Association, Oklahoma
Hospital Association, Oklahoma Primary Care Association, the FQHCs and RHCs, and the
REC through operational provider workshops and quarterly meetings to educate
providers and minimize duplication of efforts.
Collaboration with OHCA to assist providers in meeting Stage 1 Meaningful Use include
contract provisions, set out by OHCA, with pharmacies, labs, and providers that enforce
use of the OHIET network of networks.
1.5.1.7. Standards
OHIET’s execution strategy is around development and promulgation of standards within
the state in the following four, key areas:
1. Develop a process for evaluating and certifying health information organizations to
ensure that every region of the state is served by a high‐quality health information
exchange. Areas of focus for this activity will include, but not be limited to, evaluation
of governance, technology, privacy and security policies and capabilities, and financial
stability.
2. Consider, plan and implement services and technologies that are best suited to
centralized, statewide implementation, in support of the network of health
information organizations in the state. Areas of focus for this activity may include:
a. Establishment of a statewide policy for privacy and security;
b. Provision of electronic master indices services for person/provider/patient;
c. Development of state agency data services (i.e., Immunization registry, vital
statistics, etc.) to support all certified HIOs;
d. The creation of a process and/or technology to enable statewide reporting of
health and healthcare system outcome metrics from the network of HIE
networks; and
e. The potential establishment and oversight of a ‘health benefits exchange’ for
the state.
3. Identify and assemble policy and statutory changes needed to support ongoing,
appropriate, and secure health information exchange in Oklahoma and provide
information and support as needed throughout the legislative, executive, and judicial
processes required to achieve these changes.
OHIET Revised Strategic Plan Page 32
4. Interact and coordinate with equivalent organizations and leadership in neighboring
states and regions, as well as the NHIN to ensure the seamless exchange of
appropriate health information for patients receiving care in multiple states or
regions.
1.5.1.8. Accountability and Transparency
OHIET will employ rigorous accountability and transparency practices that include at least
monthly status reports to the board of trustees and to the public. The trust is subject to
the Open Meetings Act and adheres to the specific requirements therein. OHIET’s
website, www.ohiet.org provides an outlet for public review and input.
Financial accountability and transparency practices are set through the public sector and
rule‐making authority of OHIET, as well as the contractual requirements of the Office of
the National Coordinator of Health Information Technology (ONCHIT) and ARRA. OHIET’s
board of trustees has financial oversight of the organization and is led by treasurer, Sam
Guild.
Regional and local HIEs will be held accountable for appropriate implementation of HIE
practices through certification and accreditation policies of the governance entity. OHIET
vendor contracts articulate accountability and transparency requirements.
1.5.1.9. Continued Opportunities for Improvement
It is critical that all stakeholders have a place at the table in shaping HIE policy in
Oklahoma. Experience of the REC, Beacon, existing HIOs, pharmacies, laboratories,
hospitals and physicians enhance the success of OHIET. These entities participated and
strengthened the work done in the SHIECAP process to date through the oversight work
group, task forces in each domain area, and formally through other forums and informally
through each member of the large team. As OHIET evolves, it will strive to continually
take on new challenges to prepare the stakeholders within the state for later phases of
Meaningful Use and become more skilled at optimizing input from valued stakeholders.
OHIET seeks continued input through its advisory board, its consultants and through new
channels including the OHIET website and the many planned outreach programs of OHIET
and its partners.
1.5.2. Finance
1.5.2.1. Business Model
To further the efforts of OHIET, the trust will establish a budget in line with our four areas
of strategic execution, and specifically how these elements work toward meeting Stage 1
Meaningful Use across the state and set up for further meaningful use criteria:
OHIET Revised Strategic Plan Page 33
1. Evaluate and certify regional HIOs to ensure that all parts of the state are served by a
high quality HIE.
2. Develop and implement services and technologies that are best suited to centralized,
statewide implementation.
3. Identify and assemble policy and statutory changes needed to support ongoing,
appropriate, and secure health information exchange in Oklahoma.
4. Interact and coordinate with HIEs in neighboring states and regions, as well as the
Direct Project.
Key budget categories, in order to conduct OHIET business, include:
1. Human resources and support:
OHIET plans a skeletal staff, led by the Executive Director and supported by a
COO and analysts; overhead for these individuals is kept to a minimum, using
donated office space and services where possible.
They will be aided by legal, business, and domain area consultants to assist in
professional execution of OHIET work.
Financial management, oversight and reporting are required.
It is anticipated that Advisory Board committees and Trustees will provide
critical support in all these areas, allowing minimal levels of staffing in each to
accomplish OHIET business.
2. Service and technology development:
The assessment and development of products and services that would benefit
the state and the regional HIOs to centralize. This may include master indices,
data registries and vital statistics, reporting and metrics tools, etc. Focus will
be on elements that encourage and stimulate the adoption of use of the
HIOs/HIE.
3. HIE/HIO development:
Closing gaps to meet Meaningful Use includes elements from partnering with
other organizations to provide education, training and consulting services to
eligible providers, to providing financial incentives to outlying cases where the
benefits of the HIO/HIE are not immediate (i.e., in rural and/or under‐privileged
areas of the state).
4. Advocacy and policy:
Develop of policy for certification and compliance with OHIET and ONCHIT
criteria to advocacy and policy development in the legislative arena are
required for OHIET’s present and future success.
In addition to the requirements set out by SHIECAP and ONCHIT, OHIET understands the
need to generate funds at least equal those required for federal matching dollars in initial
years of operations and to then be in a position to maintain the operation and
administration of the “network of networks” in the future. This strategy is designed to
accomplish both. OHIET will build ‘value add’ products and services with an eye toward
market desirability in order to generate required revenues and become self‐sustaining.
OHIET Revised Strategic Plan Page 34
FFY 2010 began October 1, 2009.
The bulk of FFY2011 dollars will go toward ensuring Oklahoma meets Stage 1 Meaningful
Use criteria. Budget details are included in the Operational Plan, Section 2.
The establishment of statewide HIE, where every hospital and healthcare provider has
access to patient information at the point‐of‐care will cost well beyond the funding
available through this grant funding. OHIET will strive to catalyze and promote ways,
through existing, planned and future local/regional HIOs, to accomplish this ambitious
goal.
1.5.2.2. Approach to Sustainability
The federal stimulus funding is designed to last four years, at which time the Office of the
National Coordinator will hold HIEs accountable for sustainable revenue generating
business models. The HIE business models will need to deliver value to a wide variety of
stakeholders.
Several sustainability models have been considered. Because OHIET is a “network of
networks” model, customers are the state’s local and regional HIEs. Several discussions
between OHIET and representatives from planned and existing HIEs have given rise to
many ideas for value added products and services OHIET might provide for fees. Initially,
OHIET plans to provide credentialing and certification services for fees to HIOs. Ancillary
services to these, such as consultation, data sharing, etc., have revenue potential as well.
Moving beyond the first few years and as the relationships between OHIET and regional
HIEs mature, sustainability models will be designed to continually work toward raising
patient care, ensuring efficiencies, and continuing to meet state and federal goals.
1.5.3. Technical Infrastructure
1.5.3.1. Interoperability
1.5.3.1.1. NHIN Connectivity
OHIET’s interoperability strategy is to facilitate and promote connectivity across the state
and also to neighboring states via NHIN. This ”network of networks” model provides
flexibility for providers, facilities and other health‐related workers to join a network that
bests suits their geographical location, referral patterns and business model while
maximizing the ability to connect systems.
OHIET Revised Strategic Plan Page 35
OHIET will assist in the creation of HIE processes that will accommodate both federated
and centralized data connections across the state. At this time, Oklahoma intends to
federate to bordering states and the NHIN. NHIN connectivity will be prioritized as the
national effort moves forward and OHIET includes NHIN standards in certification criteria
for HIE networks.
1.5.3.1.2. Standards Adoption
OHIET’s bylaws (Appendix 3.4) establish the trust as the standard‐setting body for
Oklahoma’s statewide HIE effort. Oklahoma will adopt ONC standards and HIE
certification criteria. OHIET will facilitate the collaboration of state HIEs to determine and
develop HIE standards for the state. All entities connecting to OHIET must pass a
certification process. OHIET will assist in the streamlining of the certification process for
qualified, eligible parties.
1.5.3.2. Enabling Meaningful Use in Oklahoma
OHIET will assist providers in meeting all stages of Meaningful Use criteria. A summary of
our plan to help meet Stage 1 Meaningful Use appears in Section 1.3. OHIET recognizes
the criticality of meeting these goals by end of fiscal year 2011 and is directing all actions
toward this outcome.
Similar plans and operations for meeting goals will be developed as further stages of
Meaningful Use are defined by ONCHIT.
1.5.3.3. Approach to Technical Architecture “Network of Networks” Model
Oklahoma’s statewide HIE technical architecture strategy proposes a federated network
model and contemplates a consolidated statewide Enterprise Master Patient Index
(eMPI) and record locator service. The federated network creates the connection for the
”network of networks” approach adopted by Oklahoma. HIE networks will interconnect
to form the statewide HIE, excepting IHS participants and tribal entities (who have
established connection with NHIN and will maintain statewide connectivity via NHIN).
OHIET services will be those that are leveraged by centrality of ownership, location,
purchasing power, etc., to the benefit and use of the local HIEs. This model will be cost
effective without recreating a large centralized infrastructure or duplicating costs and
efforts of local HIEs. In addition, this will enhance OHIET’s sustainability by making it a
value‐add, low cost organization. IHS and tribal entities may either connect directly or
through a local network.
OHIET Revised Strategic Plan Page 36
Exhibit 6: Oklahoma Statewide HIE Logical Architecture
OHIET Revised Strategic Plan Page 37
Exhibit 6 depicts the Oklahoma logical statewide HIE technical approach. Networks, IHS
and tribal entities will need to be certified before exchanging live data through the
statewide network. OHIET will work to assist in timely certification of all participants
wanting to use the network.
The payors and state agencies will be encouraged to enhance their infrastructure to
connect to state HIE to perform payor‐related tasks not associated with direct clinical
care of patients. These tasks include electronic claims transactions, eligibility checking
and quality reporting. OHIET will facilitate connections with the payors and state
agencies for these functions.
1.5.3.4. Health Information Technology Components
1.5.3.4.1. Electronic Health Records (EHR)
Any EHR in the state of Oklahoma will be required to adhere to national standards,
including CCD exchange capabilities. All EHRs connected to OHIET must also adhere to
policies of privacy and security, data integrity and so forth as promulgated by OHIET.
OHIET reserves the right to remove EHRs that do not meet these requirements from the
state program.
OHIET’s role is to ascertain adoption rates and processes of state providers; identify gaps
in uptake and analyze data that lead to patterns; work with state partners and national
best practices to establish an array of solutions that will lead to meeting ONCHIT and
Meaningful Use criteria; determine roles in implementing solutions and how best OHIET
can participate; monitor closely and measure outcomes; adjust until goals are realized.
1.5.3.4.2. eMPI
The eMPI is a key component of the statewide HIE. The statewide HIE strategy to enable
cross‐network identity management is a pivotal goal for the statewide effort. Tracking
patients across networks of care, state lines and the nation to provide a continuum of
care is critical to providing patient‐centered care.
OHIET is central to establishing an eMPI for the state. At present, OHIET is working on
acquiring the bases for this data and a path to complementing it and making it available
statewide.
1.5.3.4.3. Scalability
The Oklahoma HIE strategy positions itself for future growth. Initial goals are to bolster
EHR adoption, core systems in laboratories and pharmacies and connect existing and
planned networks. This will promote use by providers seeking to achieve and
demonstrate Meaningful Use and ensure that valuable and needed data is available at the
point of care. Scalability is an important factor in meeting OHIET goals to ultimately see
HIE coverage over the entire state.
OHIET Revised Strategic Plan Page 38
OHIET���s role will be to ensure Phase 1 Meaningful Use requirements are met and then to
continue to focus on necessary elements to be required in phases 2 and 3 of Meaningful
Use, such as electronic eligibility checking, credentialing, and electronic order submission.
1.5.3.4.4. Public Health Technology
The Oklahoma State Department of Health (OSDH) is in the process of planning,
designing, developing, upgrading and expanding OSDH systems to allow EHR entities to
meet Stage 1 Meaningful Use criteria (capability for OSDH to be able to accept EHR
immunization data and verify that the Immunization electronic data submission is
successful) and Stages 2 and 3 criteria and timeframes when defined.
Specific OSDH projects have been initiated to upgrade both the Oklahoma State
Immunization Information System (OSIIS) and Laboratory Information Management
System (LIMS).
Development of an OSIIS replacement is underway to modernize the system to meet
industry best practices as well as conversion of the system to Microsoft .NET and SQL
Server technologies.
The completed OSIIS product will include an Unsolicited Vaccination Update (VXU)
database repository that is envisioned to serve as the primary repository for incoming
and future (Stage 2) outgoing Health Level Seven (HL7) messages (current projection is
HL7 V2.5.1). Stage 3 meaningful use requirements are unknown at this time.
OSDH is currently compiling information from larger Oklahoma related EHR’s and entities
for prioritization in establishing and testing standardized processes for data import into
the VXU repository. Multiple interoperability prototype projects with messaging
partners are under discussion and consideration. Among these is a prototype project with
VisionShare (now ABILITY) to receive Immunization VXU messages via DIRECT from EHRs
and forward to OSDH using PHINMS transport. This enables Immunization messaging to
OSDH via PHINMS or DIRECT.
A Request for Proposal (RFP) for the OSDH LIMS has been developed that includes
primary deliverables of HL7 accessioning, results reporting, and data repository
interfaces. The RFP is currently transitioning through the procurement process.
Simultaneous to OSIIS and LIMS development, the OSDH is proceeding with the
development and incorporation of an internal Enterprise Master Person Index (eMPI)
necessary to achieve interoperability between both internal and external systems. The
eMPI project is currently focusing on the linkage of OSDH systems including OSIIS, Vital
Records, Public Health Client Information System (PHOCIS), and other key databases and
registries of the agency. The development of an agency eMPI is considered a priority
need in assuring the OSDH can meet expected requirements for Stages 2 and 3
Meaningful Use criteria and to interact with the HIE.
OHIET Revised Strategic Plan Page 39
1.5.3.4.5. Broadband
The current status of broadband in Oklahoma is as described in Section 1.2.2 in the
Environmental Scan. Access to broadband throughout the state is a concern and OHIET is
working with the Secretary of State, Susan Savage, who leads the Oklahoma Community
Access Network (OCAN) effort to build a fiber backbone to reach across the state. In the
meantime, OHIET is working to identify feasible work‐around models that will allow
eligible providers to meet Stage 1 Meaningful Use this year. These include ASP models
and other technologies currently tested and in use in the state through SMRTNET and
others.
1.5.3.5. Approach to Clinical and Quality Assurance Measures
OHIET will regularly collect, report and monitor a set of performance measures to
accurately track the Oklahoma HIE effort and assess readiness for new phases of work. In
addition to the required measurements, OHIET will use the existing Physician Quality
Reporting Initiative (PQRI) model with de‐identified patient information and adapt it to
meet Meaningful Use criteria and requirements.
OHIET will conduct clinical and quality assurance surveys to establish baselines statistics
and update annually to capture changes over time. The planned tasks are:
• Define clinical user specifications, including data sharing requirements, data use
agreements and policies, quality‐related technology requirements, and data
access standards;
• Assist in data collection with state Medicaid and CMS for attestation and
verification of Meaningful Use by hospitals and eligible providers;
• Compile performance and evaluation metrics identified by the task forces;
• Identify best practice case studies;
• Determine performance specifications and set quality standards and goals;
• Generate strategies for incorporating best practices, lessons learned and
continuous improvement efforts;
• Create a plan, in conjunction with the REC, Beacon, existing HIOs and
organizations with high levels of adoption of EHR and HIE for dissemination of best
practices and knowledge transfer of strategies for current and future
implementations and security and protection of data;
• Highlight areas of non‐performance or under‐performance and provide analysis
on trends, exceptions, etc.
Peformance metrics and methodologies for obtaining, analyzing and reporting are
discussed in OHIET’s Operational Plan, Section 2.
OHIET Revised Strategic Plan Page 40
1.5.4. Business and Technical Operations
1.5.4.1. Implementation
The OHIET Operational Plan (Section 2) provides the particulars of implementation of the
work of OHIET. Executive oversight is provided to the organization by the seven‐member
board of trustees. Trustees have impressive records and knowledge of HIE and the health
care industry and provide perspective of clinicians, academics, hospitals, payors, IT
professionals, state agencies, regional HIEs, urban and rural settings (please see Exhibit
4). Daily operations of OHIET is performed by OHIET staff: the Executive Director, John
Calabro (also the state HIT Coordinator); the Chief Operating Officer and an analyst, both
to be named. These three individuals oversee operations conducted in each of the
domain areas, with assistance from vendors and consultants. Procurement and
contracting procedures to engage domain expertise have been established by the trust,
and follow state and federal guidelines.
OHIET benefits from the Advisory Board. An 18‐member Advisory Board has been
identified in the trust indenture (Appendix 3.3 and Exhibit 5) and an additional seven
member organizations are allowed. The Advisory Board provides representation from
healthcare providers, including those that serve low income and underserved populations
as well as from rural areas, health plans, patient or consumer organizations that
represent the population to be served, HIT vendors, health care purchasers and
employers, public health agencies, health profession schools, universities and colleges,
clinical researchers and other users of HIT such as the support and clerical staff of
providers and others involved in the care coordination of patients. The Advisory Board is
meant to advise the Board of Trustees as well as augment OHIET staff in each domain
area in the implementation phase of this work. Advisory Board members are individuals
who enjoy the concurrence on recommendations for their respective organizations. An
impressive group of individuals, many Advisory Board members have been advising and
working on domain task forces in order to inform this and the operational plan. A list of
these representatives is given in Appendix 3.8.
1.5.4.2. Project Management
Classic project management tools and approaches are in use to implement OHIET
business and conduct project work. OHIET employs individuals who have been trained
and have deep experience in the arena of project management. Project tracking tools
include scheduling, cost accounting, reporting on project progress, communications,
meeting minutes, assigned responsibilities and so on. Project management extends to
procurement in project estimating, vendor identification, due diligence, creation of bid
packages, vendor selection, contracting and contract management and oversight as well
as performance evaluation by working with vendors to take and report out specific
project metrics and to oversee remediation when metrics indicate intervention. It
extends to accounts payable by approving invoices and providing parallel tracking of work
progress to that of vendors.
OHIET Revised Strategic Plan Page 41
Quality control and assurance are key deliverables by the project management team.
Final deliverables include work conducted professionally, in keeping with the tone and
tenor of ONCHIT, on time, on or under budget and of the highest caliber.
Project management philosophy is ‘by exception’, enabling streamlining of information
for executive staff and boards. Working meetings keep running minutes of assigned tasks
with due dates and current status. Goals are established for each task force. Escalation
processes are established in line with goals. Tracked tasks and issues are escalated
according to an agreed process.
1.5.4.3. Leveraging Existing HIE Capacities and Services
OHIET services will be leveraged through existing HIOs. Multiple regional HIE efforts have
or will have HIE capacities that can be shared with the statewide effort: eMPI, e‐Rx,
immunization data, labs, prescriptions, patient look‐up, patient demographics, Record
Locator Services (RLSs) exist in current networks within the state. These services of
existing HIOs will be expanded upon to facilitate the network of networks that will form
OHIET. Alternatively, OHIET may choose to engage in new technology or other
partnerships to provide additional or extended services. Services or capabilities for the
statewide HIE will be competitively bid to take advantage of existing efforts and
economies of scale. This will facilitate a cost‐effective model without recreating a large
centralized infrastructure and duplicating costs and efforts of the existing HIOs. In
addition, this will ensure that OHIET is a sustainable organization with low, long‐term
operational costs.
1.5.4.4. Communications, Education and Marketing (CEM) Strategy
The purpose of the CEM strategy is twofold:
1. To inform, educate and engage health care providers and organizations, the
public, and other key stakeholders about the benefits of HIT adoption and use,
and HIE‐related activities in Oklahoma; and
2. To engage key stakeholder organizations that will be instrumental in helping
communicate important information to their members and constituents, and
assisting with these activities.
HIE, HIT, EHR, etc., are confusing topics to even the initiated users of such services.
Coupled with the myths and misinformation about any emerging technologies or services
as well as the confounding elements of healthcare and its ancillary services and the
landscape becomes ripe for confusion very quickly. De‐mystifying HIE and HIT and
articulating end user benefits to a widely segregated market space of direct and indirect
users are the key tasks in the CEM strategy.
Topics of the plan include:
OHIET Revised Strategic Plan Page 42
1. Overarching themes that describe and define OHIET; these include key values,
priority goals, overall mission, etc., and will result in branding, image, and
architecture for OHIET messaging.
2. Prioritization of effort aligned with ONCHIT and Meaningful Use goals that are the
initial focus of OHIET and a plan to provide CEM to critical areas; this will include
targeted communications, public awareness and education to groups essential to
achieving Stage 1 Meaningful Use criteria, and then to subsequent initiatives
critical to meet the goals and purpose of OHIET.
3. Development of materials to accomplish content of topics 1 and 2; this will include
communications packages, image and content for all media, website and user
interface, educational materials, and marketing collateral; each targeted to
specific market segments.
Generally, the project relies on current ongoing communication activities that have
proved to be successful in making information about HIE in Oklahoma available and
accessible to stakeholders in the health community. These activities play an important
role in the overall communications strategy for this project are selected and employed on
an “as needed” basis. Written presentations, meeting minutes, and other materials are
available on the OHIET website. An important element of OHIET is the ability to
collaborate; this extends to the CEM effort as well. Best practices and partnerships are
leveraged to garner the highest efficiencies in connecting with target audiences. OHIET
has already successfully collaborated with organizations such as the Oklahoma Hospital
Association (OHA), Oklahoma State Medical Association (OSMA), and the Oklahoma
Osteopathic Association (OOA) to communicate important information to providers about
HIT and HIE. Coordination of education and public awareness campaigns with the REC,
OSU and others targeting special needs populations (including work force and training
facilities) is woven into the plan. As borne out by the environmental scan, the rural areas
and the unaffiliated organizations will be priority targets in order to achieve Stage 1
Meaningful Use.
Interviews of CEM consultants have already resulted in discussions of key messages and
communications required to target a multiple segment marketplace. Communications
and education are tailored to various stakeholder audiences including Information
technology, including professional and social networking sites, are to be incorporated to
gain efficiencies and reach a broader audience, wherever possible. This aligns with
methods for information dissemination and modalities to adequately ‘connect’ with the
desired audiences including a general audience, policymakers, Oklahoma legislators,
health plans, hospitals, long‐term care, home health, physician organizations, community
clinics, public health departments, local Regional Health Information Organizations
(RHIOs), ancillary service organizations (i.e., lab, pharmacy, imaging), vendors, the public,
consumer advocates, health care payors, purchasers and employers.
Coordinated messaging with other key groups in the state who are providing public and
targeted outreach including the local HIOs, the REC, the colleges and universities and
various other groups is in the plan. Also included are activities aimed at broadening
existing collaborations to include additional health care organizations, providers and
consumers.
OHIET Revised Strategic Plan Page 43
OHIET has a value added role to play in the CEM efforts in the state. This is an
appropriate ‘central’ role where the investment will be leveraged across the state. The
plan centers on working with the regional HIOs and helping them drive the messages and
awareness required for their success.
1.5.5. Legal / Policy
1.5.5.1. Privacy and Security
Oklahoma Privacy and Security Landscape
Oklahoma generally adheres to Health Insurance Portability and Accountability Act
(HIPAA) and 42 C.F.R. Part 2 standards for use and disclosure of protected health
information (PHI), with limited exceptions for certain classes of information. Hence,
Oklahoma usually does not require authorization for exchange of Protected Health
Information (PHI) for purposes of payment, treatment or health care operations.
Examples of instances where Oklahoma may require authorization for exchange include
records containing substance abuse information,2 reportable communicable or non‐communicable
disease information,3 and certain information concerning minors.4 In
these instances, disclosure requires either authorization or additional notice concerning
the nature of records subject to disclosure.
Like other states, Oklahoma's privacy laws present some barriers to both intra‐state and
inter‐state exchange by imposing heightened requirements on certain disclosures.
Stakeholders from Oklahoma's health care community, however, have actively worked to
reduce such impediments. As participants in the HISPC process, these stakeholders
studied how to improve the state's privacy laws in order to promote secure and efficient
HIE. The HISPC process presently continues, with the initial federally‐sponsored
collaborative now functioning as a state council (OKHISPC) under a 2008 executive order
issued by Oklahoma Governor Brad Henry.
Oklahoma Health Information Exchange Legislation
To date, Oklahoma's HISPC efforts have already resulted in successful enactment of two
laws that have improved HIE in the state.
First, the HISPC collaborative worked with the Oklahoma legislature in 2007 to pass the
Oklahoma Health Information Exchange Act.5 The Act directed the Oklahoma
Department of Health to adopt and promulgate a uniform authorization for the exchange
of health information that complies with both federal and state privacy law. (Appendix
2 See 43A O.S. § 1‐109.
3 See 63 O.S. § 1‐502.2.
4 See 63 O.S. § 2602.
5 See 63 O.S. §§ 7100.1‐7100.7.
OHIET Revised Strategic Plan Page 44
3.10) The Authorization, and related patient and provider instructions, expressly sets
forth the instances where Oklahoma requires authorization for exchange and makes clear
Oklahoma does not generally require authorization for purposes of payment, treatment
and health care operations.
Second, OKHISPC worked with the Oklahoma legislature in 2008 to amend the state's
patient‐physician/psychotherapist privilege to clarify the privilege does not prohibit
disclosures of protected health information otherwise permitted under state and federal
privacy law.6
OKHISPC continues to study future opportunities to foster HIE. Further, many of
Oklahoma's HISPC council and collaborative stakeholders will also have an active role in
connection with OHIET's efforts to similarly promote HIE.
Privacy and Security Under OHIET
As further set out in Sections 1.5.5.2 through 1.5.5.5 below, OHIET will specifically require
compliance with applicable state and federal privacy laws as an express condition under
the trust agreements governing participation in the exchange. By incorporating and
applying these statutory and regulatory provisions, OHIET will clearly reference the
standards by which participants must conduct HIE.
HHS Privacy and Security Framework:
OHIET will achieve, in significant part, the eight objectives of the HHS Privacy and Security
Framework through similarly incorporating aspects of these objectives as conditions for
participation under trust agreements with exchange participants.
Individual Access:
The OHIET trust agreement will foster individual access to personal health information by
requiring exchange participants to provide access to individual records and disclosure
accounting in accordance with the Privacy Rule7 and the HITECH Act.8 Exchange
participants may provide access through a number of means, including but not limited to:
a secure web‐portal, personal health records, or direct provision of information by the
exchange participant to the individual or the individual's designee. Exchange participants
will be responsible for putting measures in place to secure the authentication of the
individual requesting access to information.
Correction:
The OHIET trust agreement will require exchange participants to comply with the Privacy
Rule9 and provide individuals with the opportunity to request corrections to PHI
generated or maintained by the exchange participant. OHIET anticipates the agreement
will also contain additional language concerning the specific manner in which exchange
6 See 12 O.S. § 2503(D)(5).
7 See 45 C.F.R. § 164.524.
8 See 42 U.S.C. § 17935(e).
9 See 45 C.F.R. § 164.526
OHIET Revised Strategic Plan Page 45
participants must provide notice and documentation of disputed information in
connection with disclosures.
Openness and Transparency:
From an organizational standpoint, Oklahoma selected the state‐beneficiary public trust
as the structure for OHIET in large part due to the inherent openness and transparency of
such entities. Oklahoma permits the creation of state‐beneficiary public trusts that
operate for the express benefit of the state and its citizens. Oklahoma law requires such
entities comply with the Oklahoma's Open Meetings Act,10 Open Records Act,11
Administrative Procedures Act,12 Public Competitive Bidding Act,13 and Public Trust
Competitive Bidding requirements.14 These acts will ensure public access and opportunity
for input and involvement in OHIET's efforts to foster HIE in Oklahoma.
From an operational standpoint, OHIET will also encourage exchange participants to
exhibit similar openness and transparency concerning participation in the exchange.
Specifically, the OHIET trust agreement will recommend exchange participants provide
patients and consumers with clear notice, preferably via the participant's Notice of
Privacy Practices, regarding how the participant will use and disclose information through
the exchange; the choices the individual may exercise with respect to the information
(e.g., access15, accounting of disclosures16, request for restriction17); and the privacy and
security measures applied to safeguard such data.
Individual Choice:
OHIET will adopt a consent model that allows for exchange of protected health
information amongst participants, in accordance with minimal necessary requirements of
the Privacy Rule18, in all instances where federal and/or state law permit disclosure
absent authorization. As noted above, exchange participants should provide individuals
with clear notice concerning these uses and disclosures through the exchange; instances
where individual authorization is necessary; and the choices individuals may exercise with
respect to protected health information.
Collection, Use, and Disclosure Limitation:
OHIET trust agreements will expressly require exchange participants to adhere to the
minimum necessary requirements of the Privacy Rule19 to govern the collection, use and
disclosure of information amongst exchange participants. Subject to such requirements,
the trust agreements will permit exchange participants to use, collect and disclose
10 See 25 O.S. §§ 3101‐312.
11 See 51 O.S. §§ 24A.1‐24A.29.
12 See 75 O.S. §§ 250‐323.
13 See 61 O.S. §§ 101‐138.
14 See 60 O.S. § 176(H).
15 45 C.F.R. § 165.524; 42 U.S.C. § 1795(e).
16 42 U.S.C. § 17935(c).
17 45 C.F.R. § 164.522; 42 U.S.C. § 17935(a).
18 See 45 C.F.R. § 164.502(b); 42 U.S.C. § 17935(b).
19 See 45 C.F.R. § 164.502(b); 42 U.S.C. § 17935(b).
OHIET Revised Strategic Plan Page 46
information for treatment, payment, health care operations and public health reporting
required by state and federal law.
Data Quality and Integrity:
Pursuant to OHIET's enabling legislation,20 OHIET trust agreements will make exchange
participants responsible for ensuring accuracy and integrity of data utilized for HIE.
Safeguards:
OHIET trust agreements will require exchange participants to comply with the Security
Rule21 provisions in order to achieve administrative, technical and physical safeguards for
accessing, maintaining and transmitting protected health information.
Further, OHIET will consider recommending a common set of procedures and
mechanisms to verify the credentials and authenticate the identity of persons requesting
and accessing information for exchange. OHIET will also consider recommending
standard privacy and security training guidelines for review and use by exchange
participants.
Accountability:
As further discussed in Section 1.5.5.3, through the express application of the Privacy and
Security Rules, along with other applicable state and federal privacy laws, OHIET trust
agreements will clearly signal exchange participants must comply with such requirements
and bear responsibility for instances of breach or other non‐compliance. In addition, the
standard procedures and training guidelines referenced immediately above could serve as
another resource toward ensuring exchange participants implement appropriate
accountability measures on an institutional level.
1.5.5.2. State Laws
OHIET anticipates working in conjunction with OKHISPC and engaging in ongoing efforts
to identify and analyze potential changes to state privacy laws to better serve HIE, both
within Oklahoma and with other states.
An Oklahoma statute subject to present discussion and analysis concerning potential
amendment requires a disclosure statement to accompany an authorization releasing
records containing reportable communicable or non‐communicable disease
information.22 The statute requires the statement to appear in bold‐faced type and
inform the individual authorizing release of the potential for inclusion of such information
in the disclosure. Stakeholders from Oklahoma's health care community and OKHISPC
have expressed concern that the detailed requirements of this statute present a barrier to
exchange.
20 See generally 63 O.S. § 1‐132(F).
21 45 C.F.R. §§ 145.302‐145.318.
22 See 63 O.S. § 1‐502.2.
OHIET Revised Strategic Plan Page 47
At the time of drafting, however, OHIET does not have any specific plans or proposals to
modify this or other state laws. Likewise, although OHIET has not yet entered into
discussions or negotiations with other states concerning HIE, OHIET will monitor HIE
efforts of other states and pursue communications with other states where doing so
could work to further inter‐state coordination and secure exchange of health information.
1.5.5.3. Policies and Procedures
OHIET anticipates utilizing the trust agreements discussed under 1.5.5.4 below as the
primary means of achieving adherence to uniform practices and procedures.
1.5.5.4. Trust Agreements
As noted throughout, OHIET trust agreements with exchange participants will serve as the
contractual mechanism OHIET will use to achieve uniform adoption of and compliance
with the consent model for exchange; the privacy and security requirements under which
exchange must occur; and the penalty provisions for acts of breach or non‐compliance
with federal or state law.
1.5.5.5. Oversight of Information Exchange and Enforcement
OHIET trust agreements will expressly inform exchange participants that oversight
authority and enforcement power for breaches and/or other acts of non‐compliance with
state and federal law rests with the government or regulatory agency charged with such
power. The standard policies, procedures, and training materials OHIET anticipates
recommending will further serve as best practices to mitigate the probability of breaches
or other misuse of information. The trust agreements will require exchange participants,
and empower OHIET, to provide notice of breaches and/or acts of non‐compliance to
appropriate government or regulatory officials where applicable law mandates such
action. Finally, the trust agreements will provide for termination of a participant's
agreement as a penalty in certain enumerated circumstances involving breach or non‐compliance
with federal or state law.
End of Oklahoma State Health Information Exchange Cooperative Agreement Program
Revised Strategic Plan
OHIET Revised Strategic Plan Page 48
Appendices
Project Month 1 2 3 4 5 6 7 8 9 101112131415161718192021222324252627282930313233343536373839404142434445464748495051
Year
Calendar Month N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J
State Trust developed
State Coordinator for HIT selected
Strategic Plan completed
Operational Plan completed
Strategic and Operational Plan approval
Evauate other certification processes
Identify elements of certification
Seek existing and planned HIO input into
certification requirements
Finalize certification process requirements
Begin certifying HIOs
Broadband program designed
Broadband program implemented
MU Incentives (Medicaid, Medicare)
inplace
Community HIO Planning Program
Designed
Community HIO Planning Program in place
HIE Voucher program designed
HIE Voucher program in place
eRX Pharmacy assistance program designed
eRx Pharmacy assistance program in place
Shared Services evaluation
Identification and prioritization of desired
shared services
Purchasing phase for shared services
Implementation of shared services
Consider Policy needs
Prioritize policy needs
Establish legislative agenda
Privacy and Security framework
Facilitate connections between HIOs and
border health systems and HIOs
Manage communications with ONC and
CMS
Strategy for interaction with Health
Benefits Exchange project
Strategy for facilitating interactions
between state agencies and HIOs
Coordination Policy Shared Services Incentive programs Certification Process
2013 2014
Planning Phase
2009 2010 2011 2012
3/31/2010 OKLAHOMA HEALTH INFORMATION TECHNOLOGY COORDINATOR 1
STATE OF OKLAHOMA
Job Description
Job Title: Oklahoma Health Information Technology Coordinator
Agency: Oklahoma Health Information Exchange Trust (“OHEIT”)
Reports To: State of Oklahoma Governor
Date Completed: March 31, 2010
Salary Range: TBD (depending upon experience)
PART I: DESCRIPTION OF POSITION
Position Purpose:
This position exists to provide leadership, direction, management and coordination of
healthcare information technology strategy for the State of Oklahoma which will include the
implementation of federal and state requirements for healthcare information technology (HIT)
and health information exchange (HIE).
This individual will work cooperatively with multiple stakeholders including health care
providers, health plans, health profession schools, consumers, technology vendors, public
health agencies, and health care purchasers to identify existing resources, needs,
commonalities of interest, project priority, and to develop a plan which prescribes the needed
activities to facilitate and expand the electronic movement and use of health information
among organizations consistent with the both state‐ and federal‐ health information
technology strategic plans.
Principal Activities: The principal activities and responsibilities include the following:
• Provide health informatics leadership, vision, and direction to the HIT office in collaboration
with the Oklahoma State Health Information Exchange Governance Committee.
• Provide expertise, including research and analysis required to establish and maintain a
strategy for implementing health information exchange in Oklahoma
• Identify new grant opportunities; serve as principle investigator (PI) as needed for grants
and direct the preparation of grant applications for funding for planning and implementing
HIT/HIE in Oklahoma.
• Review grant proposals to evaluate informatics components for issues relating to readiness,
collaboration, interoperability and certification.
• Assist HIT projects with conducting studies of existing and proposed information systems
and their impacts.
• Collect and analyze data on statewide HIT systems.
• Prepare written and oral reports, manuscripts and other communications summarizing the
findings of analyses and studies and disseminate the results.
• Present data, study findings and recommendations to the Governance Board, Advisory
Board, state agencies, legislators and other partners/stakeholders as needed to support the
statewide HIT/HIE system decision‐making process.
• Act as the State lead for HIT/HIE and participate in state, regional and national
health/scientific meetings focused on HIT/HIE.
3/31/2010 OKLAHOMA HEALTH INFORMATION TECHNOLOGY COORDINATOR 2
• Act as the designated Oklahoma representative at meetings related to HIE and associated
grants
• As needed, serve as an interface between the partners/stakeholders and the OHEIT staff on
identifying and addressing informatics issues.
• Coordinate statewide activities related to the implementation of HIT/HIE in Oklahoma in
order to improve the efficiency and effectiveness of health data collection, analysis and use
to improve the health of individuals and their communities.
• Provide direction in the development of the state HIT/HIE strategic plan.
• Coordinate resources and activities to assist with readiness assessments of public and
private health care entities to implement electronic information systems that meet federal
and state requirements and fit within the state HIE plan.
• Solicit input from relevant public and private partners/stakeholders, including consumers,
about the needs and barriers to implementing HIE in Oklahoma including barriers to
interoperability and ways to utilize opportunities and reduce barriers.
• Foster pilot projects and coordinate HIE‐related activities in collaboration with public and
private healthcare providers and health plans.
• Collaborate with federal standards and policy committees to develop common data
reporting formats and methods of transmission within Oklahoma and across state borders
for all pertinent health data.
• Maintain relationships with public and private partners/stakeholders for the purpose of
insuring coordination of all electronic health information systems planning, development,
implementation and interoperability.
• Provide training and information on ONC, NHIN administrative and technical requirements
for system interoperability and secure data exchange using the Web and other
communication methods.
• Perform other duties in support of the statewide HIT activities.
• Represent Oklahoma on national HIE/HIT issues and activities.
Supervisory Responsibilities: This position has supervisory responsibilities.
PART II: KNOWLEDGE AND BACKGROUND REQUIREMENTS
Qualifications:
This position requires a strong leader possessing excellent health informatics skills and strong
experience with information systems and information technology. The work of this position
requires expert knowledge of healthcare processes and systems both private and public,
program management, technological planning, organizational behavior, public policy
development and analytical evaluation and research skills. It requires the incumbent to develop
a strong working knowledge of the statewide private sector healthcare infrastructure;
information technology, medical informatics, legislative processes and operation of state
agencies.
Preference: Preference will be given to applicants with the following qualifications:
• An individual with an advanced clinical degree including nursing, medicine, dentistry or
pharmacy.
• An individual with clinical practice experience.
3/31/2010 OKLAHOMA HEALTH INFORMATION TECHNOLOGY COORDINATOR 3
• Masters or higher degree.
• Significant expertise and knowledge in HIT/HIE, particularly related to improving clinical
quality.
• Significant knowledge and experience in HIT/HIE public policy.
• Recognized leadership skills and experience in managing, creating or developing health
information technology.
• Extensive knowledge of information management principles, information technology
strategies and trends, and systems oversight abilities.
Qualified candidates will possess the following:
Education: Post baccalaureate degree from an accredited college or university with additional
training in business administration, public administration, finance, management information
systems, public health, health care management, or medical informatics.
Experience: Seven (7) years of pertinent work experience within the healthcare and/or public
health or industry. Three (3) years of program or project management experience which
include:
• Analyzing business processes and outcomes
• Financial reporting
• Planning, developing, and implementing information technology systems
• Managing large projects
• Writing and administrating grants
• Facilitating meetings Researching, interpreting and explaining technical information such as
laws, regulations and requirements.
Language Skills: Ability to read, analyze, and interpret technical documents, general business
periodicals, professional journals, technical procedures, or governmental regulations. Ability to
write reports, business correspondence, and procedure manuals. Ability to effectively present
information and respond to questions from stakeholders.
Mathematical Skills: Ability to work with mathematical concepts such as probability and
statistical inference with the ability to apply concepts to practical situations.
Reasoning Ability: Ability to solve practical problems and deal with a variety of concrete
variables in situations where only limited standardization exists.
Computer Literacy: Knowledge of health information technology concepts, including hardware,
software, networking, and associated costs and budgeting. Must have significant knowledge of
healthcare data standards (vocabularies, messaging, and security) and experience in
communicating these complex topics to learners and listeners at all levels.
Physical Demands/Work Environment: Reasonable accommodations may be made to enable
individuals with disabilities to perform the essential functions.
To: Advisory Board Member Organization
RE: Appointment of Personnel to Serve with the Oklahoma Health Information
Exchange Trust Advisory Board
Dear :
Recently passed into Oklahoma Legislation by Senate Bill 1373 was the establishment of a
public trust, the Oklahoma Health Information Exchange Trust (OHIET). The purpose of
OHIET is to ensure complete coverage of the state by health information exchanges (HIEs)
and transmission of electronic health data both intra‐ and interstate thereby raising the
overall quality of health of the population while making access more effective and
affordable.
Your organization has already made significant contribution to this (the Oklahoma State
Health Information Exchange Cooperative Agreement Program) and other areas of
HIT/HIE. Because of your commitment and leadership, we have included your
organization as a founding member of OHIET’s Advisory Board.
Request:
The Board of Trustees of OHIET requests that you nominate one individual to serve as your
representative. This individual should be a leader in your organization; they should
represent a consensus opinion of your organization; they should bring a deep level of
understanding of your organization and the constituencies you serve; they should be
willing to collaborate with a diverse set of views and devise creative paths and solutions;
they should be critical thinkers and have the ability to understand and eliminate bias.
Depending upon the role your representative takes, the time commitment from him/her
will range from one to four hours per week. We ask that representatives serve for a
minimum term of one year.
We very much appreciate your generosity in allowing this valuable employee to work with
us. We believe, with the assistance of organizations like yours, we will improve the overall
quality of care for the citizens of Oklahoma.
Once you have selected your representative, please send notification to this office,
_____________. We look forward to learning your member individual by October 15, 2010.
Thank you once again the effort you and your organization put toward these endeavors.
Signed by Trustees
Follows: more information about the position, Advisory Board and OHIET.
To: Advisory Board Member Organization
Re: Appointment of Personnel to Serve with the Oklahoma Health Information Exchange Trust Advisory Board
2/8
Position Purpose:
To represent the views and desires of your organization, to collaborate with several other
concerned constituents, and to add leadership and expertise to the Oklahoma Health
Information Exchange Trust (OHIET) and towards its intentions to meet stated goals. To
provide opinion and advice to the Board of Trustees; to work on task forces at a domain‐specific
level in order to make learned recommendations to the Board; to perform discrete
tasks as might be necessary.

Submitted To:
Office of National Coordinator for Health Information Technology
Department of Health and Human Services
Regarding:
American Recovery and Reinvestment Act
State Health Information Exchange Cooperative Agreement Program
Opportunity #EP-HIT-09001
CFDA# 93.719
Every Oklahoman will
benefit from the improved
quality and decreased cost
of health care afforded by
the secure and appropriate
communication of their
health information to all
providers involved in their
care, raising the health
status of individuals and
the entire state population.
– Oklahoma Health
Information Exchange
Trust Vision Statement
Oklahoma’s Revised Strategic Plan
for the
State Health Information Exchange Cooperative
Agreement Program (SHIECAP)
Submitted by:
Oklahoma Health Information Exchange Trust
March 11, 2011
OHIET Revised Strategic Plan Page 1
Table of Contents
Page
1. Strategic Plan
1.1. Oklahoma Approach to Health Information Technology .................................4
1.1.1. History of Health Information Technology in Oklahoma .............................. 4
1.1.2. Vision, Mission and Goals of Oklahoma Health
Information Exchange Trust ...................................................................... 6
1.1.3. Purpose of Oklahoma Health Information Exchange Trust ........................... 9
1.1.4. Operations Plan Elements ........................................................................... 11
1.2. Environmental Scan Outcomes in Oklahoma.................................................. 12
1.2.1. Current and Planned HIOs for Oklahoma .................................................... 12
1.2.1.1. Heartland HealthNet.............................................................................. 13
1.2.1.2. SMRTNET................................................................................................ 13
1.2.1.3. OPHX ...................................................................................................... 13
1.2.1.4. GOCHC.................................................................................................... 14
1.2.1.5. GTHAN.................................................................................................... 14
1.2.1.6. Summary of the Current Gaps in HIE in the State of Oklahoma ........... 14
1.2.2. Broadband.................................................................................................... 14
1.2.3. Levels of Technology Development and EHR Adoption in Oklahoma......... 18
1.2.4. E‐prescribing Readiness and Adoption........................................................ 19
1.2.5. Laboratory Readiness................................................................................... 20
1.2.6. Additional Statewide Readiness .................................................................. 22
1.3. Oklahoma’s Strategy for Stage 1 Meaningful Use .......................................... 23
1.4. Health Information Exchange Coordination Strategies................................... 26
1.5. Domain Area Strategies ................................................................................. 27
1.5.1. Governance ................................................................................................. 27
1.5.1.1. Structure to Achieve Results ................................................................. 27
1.5.1.2. Decision Making Authority .................................................................... 28
1.5.1.3. Set Up and Membership Representation ............................................. 29
OHIET Revised Strategic Plan Page 2
1.5.1.4. Oklahoma Health Information Technology Coordinator ...................... 30
1.5.1.5. Alignment with Nationwide Health Information
Network Governance ........................................................................ 30
1.5.1.6. Alignment with State Medicaid Hit Plan ............................................... 30
1.5.1.7. Standards .............................................................................................. 31
1.5.1.8. Accountability and Transparency ......................................................... 32
1.5.1.9. Continued Opportunities for Improvement .......................................... 32
1.5.2. Finance ........................................................................................................ 32
1.5.2.1. Business Model ......................................................................................... 32
1.5.2.2. Approach to Sustainability ....................................................................... 34
1.5.3. Technical Infrastructure .............................................................................. 34
1.5.3.1. Interoperability ........................................................................................ 34
1.5.3.1.1. Nationwide Health Information Network Connectivity......................... 34
1.5.3.1.2. Standards Adoption ............................................................................... 35
1.5.3.2. Enabling Meaningful Use in Oklahoma..................................................... 35
1.5.3.3. Approach to Technical Architecture: “Network of Networks” Model ..... 35
1.5.3.4. Health Information Technology Components .......................................... 37
1.5.3.4.1. Electronic Health Records ..................................................................... 37
1.5.3.4.2. eMPI....................................................................................................... 37
1.5.3.4.3. Scalability .............................................................................................. 37
1.5.3.4.4. Public Health Technology ...................................................................... 38
1.5.3.4.5. Broadband ............................................................................................. 39
1.5.3.5. Approach to Clinical and Quality Assurance Measures............................ 39
1.5.4. Business and Technical Operations ............................................................. 40
1.5.4.1. Implementation ........................................................................................ 40
1.5.4.2. Project Management ............................................................................... 40
1.5.4.3. Leveraging Existing Health Information Technology
Capacities and Services .......................................................................... 41
1.5.4.4. Communications, Education and Marketing Strategy.............................. 41
OHIET Revised Strategic Plan Page 3
1.5.5. Legal / Policy ............................................................................................... 42
1.5.5.1. Privacy and Security ................................................................................ 43
1.5.5.2. State Laws ............................................................................................... 46
1.5.5.3. Policies and Procedures .......................................................................... 47
1.5.5.4. Trust Agreements .................................................................................... 47
1.5.5.5. Oversight of Information Exchange and Enforcement ........................... 47
2. Operational Plan (under separate cover)
3. Appendices – Strategic and Operational Plans 48
3.1 Project Schedule ............................................................................................ 49
3.2 Legislation, Senate Bill 1373 .......................................................................... 50
3.3 Oklahoma Health Information Exchange Trust Indenture ............................ 58
3.4 Oklahoma Health Information Exchange Trust Bylaws ................................ 78
3.5 Oklahoma Health Information Technology Coordinator Position Description 91
3.6 Governor Henry’s State Designation Letter .................................................. 94
3.7 Position Description of Advisory Board Members......................................... 96
3.8 List of Participants in Oklahoma State Health Information Exchange
Cooperative Agreement Program .............................................................. 104
3.9 Glossary of Acronyms .................................................................................... 107
3.10 Oklahoma Standard Authorization to Use or
Share Protected Health Information (PHI)................................................. 110
3.11 Letters of Endorsement ................................................................................. 112
3.12 Parity Check with PIN .................................................................................... 119
3.13 Governor Henry’s Re‐Designation Letter....................................................... 125
3.14 Biographical Information on OK’s HIT Coordinator ....................................... 126
3.15 Resumes of OHIET Trustees........................................................................... 129
OHIET Revised Strategic Plan Page 4
1. Strategic Plan
1.1. Oklahoma Approach to Health Information Technology
1.1.1. History of Health Information Technology in Oklahoma
For over half a decade, collaborative efforts of public and private entities have
established a strong foundation from which Oklahoma draws support for advancing
Health Information Exchange (HIE) under the State Health Information Exchange
Cooperative Agreement Program (SHIECAP).
In 2004, Oklahoma took an initial step toward development of a state HIE by participating
in the Health Information Security and Privacy Collaborative (HISPC) program. Through
HISPC, a broad base of stakeholders from Oklahoma's health care community, including
providers, payors, government agencies, professional trade organizations and private
consumer advocates, collectively identified barriers and studied how to overcome them
while promoting a secure HIE. This key work culminated in the enactment of the
Oklahoma Health Information Exchange Act, allowing a Standard Authorization Form for
sharing protected health information. The form can support exchange of either paper or
electronic medical records and serves as a valuable education resource for consumers
concerning the scope of exchanges requiring authorization under federal and state
privacy law. The initial HISPC collaborative workgroup continues to exist as a council
pursuant to a 2008 executive order issued by Oklahoma Governor Brad Henry. (This
group is represented in the advisory board of the new Oklahoma Health Information
Exchange Trust (OHIET), the state designated entity (SDE) for Oklahoma’s SHIECAP funds
and activities.)
In 2005, the Secure Medical Records Transfer Network (SMRTNET) became one of
Oklahoma's first operational regional health information organizations (HIO). Since that
time, a number of other exchanges have emerged within the state, including Heartland
HealthNet, Oklahoma Physicians Health Exchange, Greater Oklahoma City Hospital
Council Exchange (GOCHC), and the Greater Tulsa Health Access Network (Greater THAN).
These exchanges have connected healthcare providers from both urban and rural areas,
health systems and public partners for purposes of data exchange.
In 2008, Oklahoma received notice of its selection as one of 12 communities to
participate in the Center for Medicare and Medicaid Services (CMS) Electronic Health
Records (EHR) Demonstration Project. Although CMS cancelled this project in 2009 to
align funding opportunities with those passed under the American Recovery and
Reinvestment Act of 2009 (ARRA), Oklahoma's selection reflected the state's record for
advancing HIE through multi‐stakeholder involvement and readiness for adoption and
exchange using Health Information Technology (HIT).
OHIET Revised Strategic Plan Page 5
Oklahoma’s HIE History at a Glance
Year Event Results
2004 OK participates in HISPC • OK HIE Act
• Standard Authorization Form
2005 SMRTNET (state’s first HIO) became
operational
• Paved way for several other regional HIOs
2008 OK selected for CMS EHR demonstration
project
• Acknowledgment of accomplishments of
HIE in OK
2009 Health Information Infrastructure
Advisory Board (HIIAB) set up by
legislature
• OHCA became hub for state agencies
exchange
2010 Oklahoma Health Information Exchange
Trust (OHIET) set up by legislature
GTHAN receives Beacon Community
grant
• OHIET became SDE for OK SHIECAP and
governance of state HIE
• Major new HIE for NE OK
In 2009, the Oklahoma legislature demonstrated Oklahoma's commitment to HIE
amongst government agencies by enacting legislation that created the Health Information
Infrastructure Advisory Board (HIIAB). The board is comprised of a number of state
agencies involved in various aspects of public health. The legislation directed the board
to assist Oklahoma's Medicaid Agency, OHCA, in developing strategic approaches for
adoption of electronic medical records technologies and HIE. The legislation also directed
OHCA to serve as the hub for exchange amongst state agencies.
Finally, Oklahoma’s 2010 legislative session enacted SB 1373, setting up a new public
trust, the Oklahoma Health Information Exchange Trust (OHIET). OHIET serves as the
organizational structure and state‐designated entity (SDE) for SHIECAP funding and
activities. OHIET is a state‐beneficiary public trust created under legislation expressly
aimed at establishing an entity capable of serving not only as Oklahoma's permanent SDE
during the SHIECAP grant period, but that will also ensure the state meets future
meaningful use requirements and the full advancement of HIE throughout the state.
Working closely with the state’s Regional Extension Center (REC), Beacon Community,
other HIOs, and our broadband initiatives, OHIET will expand existing resources and
leverage new and increasing resources to promote future HIE activities and meet the
goals set by ONCHIT.
OHIET Revised Strategic Plan Page 6
1.1.2. Vision, Mission and Goals of OHIET
Vision Statement:
Every Oklahoman will benefit from the improved quality and decreased cost of healthcare
afforded by the secure and appropriate communication of their health information to all
providers involved in their care, raising the health status of individuals and the entire
state population.
Mission Statement:
OHIET will enable all Oklahoma providers to rapidly locate and access sources of patient
data maintained anywhere in the state, in accordance with all state and federal laws.
OHIET will facilitate electronic access to shared patient data utilizing a single query which
may be submitted either in conjunction with, or separate from, an electronic medical
record.
OHIET will operate in a secure environment and will eventually be self‐sustaining ‐‐ not
relying upon state‐appropriated funds.
OHIET will ensure that key data elements, as required for Meaningful Use and patient
safety, be accessible statewide and nationally, including the Nationwide Health
Information Network (Direct) and will include structured lab data, pharmacy data, and
immunizations from all willing and available providers whom contract with Medicaid
across the state, as relevant for the provider type.
OHIET will work with providers, state agencies, payors and stakeholder organizations to
develop and operate statewide HIE capabilities via a network of networks, which will be
electronically accessible to all participating providers.
OHIET will work with all stakeholders to provide operational oversight1 and to create and
adopt standards, master patient identification protocols, provider indices, record locator
services, and related technical infrastructure to assure statewide access to patient data
regardless of which HIE network houses the patient data.
OHIET will ensure seamless and secure integration and transmission of data throughout
all HIE networks in Oklahoma and into neighboring networks. OHIET will leverage existing
HIE infrastructure, both operational and planned, to close service and care gaps and
facilitate urban, suburban and rural connections for all willing hospitals and providers.
OHIET will advocate for the use of HIE/HIT by all providers and patients throughout the
state, as well as promote legislation and policies that will enhance and enable effective
use of HIE/HIT.
OHIET will assist in the public awareness and education on information, use and merits of
the HIE and HIT systems.
1 Intended to reflect the participatory management created by the Advisory Board, as well as the ”network
of networks” concept where individual networks participating in the state HIE manage their own data and
operations. This also assures that the state won’t usurp operational control of these networks.
OHIET Revised Strategic Plan Page 7
OHIET may either subsidize the expansion of coverage into service gap areas with
financial support for interface development or related infrastructure needs, and/or
contract directly with vendors to address unmet needs, as required. OHIET is not
obligated to support or encourage any single HIE effort, but is intended to act in the best
interest of the providers and patients of Oklahoma. OHIET may provide financial support
for the development of basic needs common to all Oklahoma‐based HIE networks.
OHIET will collaborate and coordinate with other ARRA funded initiatives in the state
including the Regional Extension Center and Beacon Community efforts to leverage
resources, avoid duplication of cost and work efforts, and share best practices.
OHIET Clinical Quality and Performance Improvement Goals include:
Oklahoma is one of the worst‐performing states in healthcare in the nation. The
Commonwealth Fund, both in 2007 and again in 2009, ranked Oklahoma’s overall health
system 50th among the states in the United States. Public health researchers have
observed that Oklahomans born today have a shorter age‐adjusted life expectancy than
their parents. Clear gaps are evident in the performance of the health systems..
Oklahoma believes a strong HIE infrastructure is a key element to alleviate health
disparities in our state and raise the overall health quality. OHIET is collaborating with
the REC, our Beacon Community and the regional HIOs in the state, to align efforts to
meet HIE goals and objectives.
OHIET Revised Strategic Plan Page 8
OHIET Clinical Quality and Performance Improvement Goals
State Objectives
(Qualitative Targets)
Measurable Outcomes
(Quantitative Targets)
Anticipated Health IT
Outputs
(Target Year)
COST-EFFICIENCY Justification: Oklahoma ranks 45th in the nation in terms of re-hospitalization
rates. Improving HIE usage will result in fewer re-hospitalizations
and duplicated services, thereby lowering health care
expenditures by an estimated 5-7%.
10% reduction in overall hospital
readmissions and ED visits regarding
asthma, COPD and CHF
CE1: Reduce preventable
hospitalizations and Emergency
Department visits for Ambulatory
Care and sensitive conditions
5-7% decrease in total aggregate State
Medicaid and Medicare expenditures
CE2: Reduce duplicate and
inappropriate testing, diagnostic
procedures, and specialty referrals
Reduce the number of duplicate lab
tests by 10%; reduce referrals to
specialty care by 10%
CE3: Reduce costs for duplicate
technologies/eMPI/governance and
legal across providers, institutions
and other ARRA efforts
TBD
Advanced HIE
implementation rates and
provider adoption rates
beyond 75% (2015)
QUALITY OF CARE Justification: Connecting underserved populations to HIEs will allow
faster access to other facilities and specialists and support
improvements to transitions of care. Increasing the number of HIE
users leads to better communication and more accurate diagnoses,
thereby improving medication reconciliation and reducing the number
of adverse drug events or medical errors.
QC1: Increase timely access to
specialty care for rural, tribal,
uninsured and other potentially
underserved populations
Decrease patient wait times for initial
specialist opinion to 10 business days
via HIE messaging and e-referrals. (We
are testing this data on a regional
basis.)
QC2: Improve transitions of care and
patient safety by improving the
medication reconciliation process
TBD
Enhanced communication
between healthcare
providers
(2015)
OHIET Revised Strategic Plan Page 9
and accuracy across inpatient
settings and provider offices
POPULATION HEALTH Justification: The Oklahoma State Health Rankings demonstrates how
all the goals tie to health disparities. Increasing statewide vaccination
rates and prevention screening will improve care for those currently
whose needs are currently unmet, thereby reducing health disparities.
In addition, chronic disease management efforts can be focused on
high-risk populations due to improved HIE tools for communication
and epidemiological analysis.
10% increase in the number of
Pneumovax and Influenza vaccinations
10-20% increase in the number of lipid
panels performed
PH1: Increase the number of
patients using preventative services
3-5% increase in the number of
patients having regular mammograms
and PSAs
PH2: Improve public health
outcomes for CHF, DM, smoking
cessation and alcohol usage
5-10% reduction in smoking rates and
alcohol usage. Reduction of 1% in
population aggregate HgA1C for DM.
Decrease CHF admissions by 10%
Evaluation tools that allow
for advanced analytics and
performance feedback
systems (2015)
1.1.3. Purpose of OHIET
OHIET has the following items expressly delineated into the articles of indenture for the
public trust:
a) Establish and maintain a framework for the statewide exchange of health
information, and encourage the widespread adoption and use of EHR systems
among Oklahoma health care providers, hospitals, pharmacies, laboratories,
payors and patients.
b) Promote and facilitate the sharing of health information among health care
providers within Oklahoma and in other states by providing for the transfer of
health information, medical records and other health data in a secure
environment for the benefit of patient care, patient safety, reduction of
duplicate medical tests, reduction of administrative costs and any other
benefits deemed appropriate by the trust.
c) Establish and adopt minimum standards and requirements for the use of
health information and the requirements for participation in trust‐certified
OHIET Revised Strategic Plan Page 10
HIEs for persons or entities including, but not limited to, health care
providers, payors, laboratories, pharmacies and local HIEs.
d) Establish minimum standards for accessing the HIEs certified by the trust to
ensure that the appropriate security and privacy protections apply to health
information, consistent with applicable federal and state standards and laws.
The trust shall have the power to suspend, limit or terminate the right to
participate in certified HIE for non‐compliance or failure to act, with respect
to applicable standards and laws, in the best interests of patients, users of
certified HIE or the public. The trust may seek all remedies allowed by law to
address any violation of the terms of participation in certified HIE or
applicable statutes and regulations.
e) Identify and overcome barriers to the adoption of EHR systems. Efforts may
include assistance with broadband initiatives and researching the rates and
patterns of dissemination and use of EHR systems throughout the state.
Partner closely with the REC and professional organizations to ensure rural
Oklahoma providers, hospitals, laboratories and pharmacies can contribute
and receive data via HIE.
f) Solicit and accept grants, loans, contributions or appropriations from any
public or private source and expend those moneys, through contracts, grants,
loans or agreements, on activities it considers suitable to the performance of
its duties.
g) Determine, charge and collect appropriate fees, charges, costs and expenses
from certified healthcare provider or entity in connection with its contractual
duties.
h) Employ, discharge or contract with staff, including administrative, technical,
expert, professional and legal staff, as is necessary or convenient to carry out
the purposes stated in this Article III (Please see Appendix 3.3, OHIET
Indenture) .
i) To plan, establish, develop, construct, enlarge, remodel, improve, make
alterations, extend, maintain, equip, operate, lease, furnish and regulate
inter‐HIE exchange for the benefit of patients.
j) To construct, install, equip and maintain any hardware, software, technology,
equipment and programs necessary for the interoperability of HIEs certified
by the trust.
k) To construct, equip and maintain any facilities for the development,
maintenance and operation of the interoperability HIEs certified by the trust.
l) To acquire by lease, purchase or otherwise, and to plan, establish, develop,
construct, enlarge, improve, extend, remodel, maintain, equip, operate,
furnish, regulate and administer any and all physical properties (real, personal
or mixed), intellectual properties (copyrights, trademarks, patents, licenses),
rights, privileges, immunities, benefits and any other things of value,
OHIET Revised Strategic Plan Page 11
designated or needed in establishing, maintaining and operating the core
components required for the interconnection of multiple exchanges.
m) To finance, refinance and enter into contracts of purchase, lease‐purchase or
other interest in, or operation and maintenance of, the properties and other
assets listed in paragraphs (e) and (f) above, and revenue thereof, and to
comply with the terms and conditions of any such contracts, leases or other
contracts made in connection with the acquisition, equipping, maintenance
and disposal of any of said properties; and to relinquish, dispose of, rent or
otherwise make provisions for properties owned or controlled by the trust
but no longer needed for trust purposes.
n) To transact business anywhere in the state of Oklahoma to the extent it
benefits the citizens of the beneficiary.
o) To provide funds for the cost of financing, refinancing, acquiring, constructing,
purchasing, equipping, maintaining, leasing, repairing, improving, extending,
enlarging, remodeling, holding, storing, operating and administering the core
components required for the interconnections of HIEs and any or all of the
properties and assets indicated in paragraphs (e) and (f) above needed for
executing and fulfilling the trust purposes as set forth in this instrument and
all other charges, costs and expenses necessarily incurred in connection
therewith and in so doing, to incur indebtedness, either unsecured or secured
by all or any part of the trust estate and its revenues.
p) To expend all funds coming into the hands of the trustees as revenue or
otherwise for the payment of any indebtedness incurred by the trustees for
purposes specified herein, and in the payment of the aforesaid costs and
expenses, and in payment of any other obligation properly chargeable against
the trust estate, and to distribute the residue and remainder of such funds to
the beneficiary upon termination of the trust.
1.1.4. Operations Plan Elements
In the Operations Plan that follows, execution of OHIET strategies are outlined in six key
areas, as follows. Emphasis, in the Operations Plan for the first year is around executing
these elements in pursuit of meeting Stage 1 Meaningful Use in Oklahoma.
1. Develop a process certifying health information organizations to ensure that
every region of the State is served by a high‐quality health information
organization. Areas of focus for this activity will include, but not be limited to,
evaluations of governance, technology, privacy & security policies and capabilities,
and financial stability.
2. Design grant programs that fit the overall state strategy to meet S1MU and
following meaningful use stages.
3. Ensure the plan, development and implementation of shared services and
technologies that are best suited to centralized, statewide implementation, in
support of the network of health information organizations in the State. Areas of
OHIET Revised Strategic Plan Page 12
focus for this activity include a) a state‐wide policy for privacy and security, b) an
electronic master person, provider, or patient index services and/or standards, c)
state agency data services (i.e. immunization registry, vital statistics, etc.) to
support all certified HIOs, d) a process and/or technology to enable state‐wide
reporting of health and healthcare system outcome metrics from the network of
HIO networks, and e) and participation in a health insurance exchange for the
state.
4. Identify and assemble policy and statutory changes needed to support ongoing,
appropriate, and secure health information exchange in Oklahoma and provide
information and support as needed throughout the legislative, executive, or
judicial processes required to achieve the changes.
5. Coordinate activities for Inter‐HIO, Inter‐HIT (i.e., Beacon, Challenge, Benefits
Exchange grants) and Interstate HIE, to ensure the seamless exchange of
appropriate health information for patients receiving care in multiple states or
regions and to streamline efforts and resources expended.
6. Evaluate and monitor the continuing HIE activities throughout the state and
others that may impact our state HIE endeavor.
1.2. Environmental Scan Outcomes for Oklahoma
1.2.1. Current and Planned HIOs for Oklahoma
The environmental scan depicts Oklahoma’s multiple regional HIEs in their varying stages
of development or operation. The regional HIEs are the foundation for the statewide
“network of networks” and are committed to participate in a statewide interoperable
exchange of healthcare data and the attendant enabling activities. Each regional HIE is
described further in this section. EHR adoption rates were higher than expected for
providers eligible for incentive payments. Understanding of EHR functionality by office
staff, however, was shown to be sub‐optimal and an area of needed focus to meet OHIET
objectives.
All HIEs included in this study are focusing on the core elements of the CCD including
demographics, drug allergies, prescription history, coded problems, structured lab data
and the ability to both receive data and transmit data. These HIE have contributed to the
growing set of standards that will be adopted by OHIET.
Areas of focus for both the REC and OHIET include functionality to meet meaningful use in
both e‐prescribing and lab ordering and reporting. OHIET, the REC and the regional HIOs
have incorporated faculties to ensure all providers, hospitals, pharmacies and
laboratories have appropriate information and guidance to enable/select their core EHR
and institutional electronic systems and extending these services to all areas of the state.
OHIET Revised Strategic Plan Page 13
NHIN Direct may be leveraged as an agent to deliver HIE for those providers and hospitals
that choose not to participate in an existing or future network within the OHIET network
of networks.
A summary of each HIE follows.
1.2.1.1. Heartland HealthNet
Heartland HealthNet is owned by the Oklahoma State University Center for Health
Sciences (OSU‐CHS). Its membership is comprised of rural critical access hospitals and
OSU faculty. Heartland HealthNet currently exchanges referral data within its HIE. The
exchange of clinical data is planned for a summer 2010 implementation. Heartland
HealthNet’s original mission to connect four small rural hospitals to a large tertiary
hospital center has grown to include OSU adjunct faculty and clinics.
Heartland HealthNet is based on Covisint’s ExchangeLink product. Cloud applications are
available to bring services into a customized view. ExchangeLink also supports interfaces
to the majority of EHR vendors.
1.2.1.2. Secure Medical Records Transfer Network of Oklahoma (SMRTNET)
SMRTNET is a public non‐profit system of networks including Greater Oklahoma City
Hospital Council GOCHC, Norman Physician Hospital Organization (NPHO), Open Access
Network for all Oklahoma providers, the northeast Oklahoma network, and the Health
Alliance for the Uninsured. SMRTNET has also supplied HIE planning services to the
Greater Tulsa Health Access Network (Greater THAN, a Beacon Community network),
Tulsa Hospital Council, the state’s community health centers, and several other networks
currently in development. Networks using SMRTNET share over $2 million in assets and
harmonize HIE to HIE data exchange through common policy, consensus management,
shared legal documents and shared security measures.
The current shared SMRTNET database includes a master patient index (MPI) of
approximately 4 million patients, 16 million diagnoses, 52 million immunizations/results,
and data provided by over 11,000 providers from all 77 counties in the state of Oklahoma.
SMRTNET is exchanging data across urban, suburban and rural care areas and includes
both hospital and ambulatory data. SMRTNET currently includes structured data for
diagnosis, immunizations, drug allergies, medications, laboratory results and incorporates
e‐prescribing through its portal. Thousands of physicians, practitioners and nurses across
the state are currently and actively using SMRTNET to provide safe and high quality
patient care.
SMRTNET evolved as part of an Agency for Healthcare Research and Quality (AHRQ) effort
to develop working model HIEs for the country. The outcome is successfully providing
networking services that include private providers, hospitals, Native American tribes,
state agencies, universities and mental health facilities. The cost to develop this capacity
has exceeded $4 million over a five‐year period. Currently, there are 46 entities
exchanging data across Oklahoma; 23 in the rural areas and 23 in urban areas.
OHIET Revised Strategic Plan Page 14
1.2.1.3. Oklahoma Physicians Health Exchange (OPHX)
Norman Physician Hospital Organization (NPHO) is operating an integrated clinical
network using a community EHR. NPHO selected eClinicalWorks as the platform to create
a community electronic record for patients. Electronic Health Exchange (eEHX) provides
interoperability between the NPHO physicians, ambulatory centers and hospitals
connecting their EHRs. Additional data sources and services have been added to the
OPHX by joining SMRTNET as an affiliate. Approximately 150 providers in the Norman
and Purcell areas participate in the OPHX effort. OPHX currently allows the secure
passage of a CCD, electronic messaging, referrals, laboratory orders, results and
prescription history.
1.2.1.4. Greater Oklahoma City Hospital Council Exchange (GOCHC)
GOCHC started with nine hospitals to form a regional HIE to improve the efficiency and
overall coordination of care to all patients. GOCHC began its initiative three years ago
with a special focus on caring for the uninsured presenting in emergency departments.
The focus has expanded well beyond the ER to include all providers, hospitals and data
contributors in the greater Oklahoma City region. The exchange has grown to 30 hospital
members across the state and the Health Alliance for the Uninsured clinics. The GOCHC
exchange is a SMRTNET affiliate with a separate governing body.
1.2.1.5. Greater Tulsa Health Access Network (GTHAN)
GTHAN exists to improve health outcomes for the citizens of the greater Tulsa area. The
project has received a $12 million Beacon Community grant from ONC. The HIE will
provide access to 1,600 providers and improve the care coordination and disease
outcomes of their patients. The group has selected Covisint ExchangeLink to accomplish
the task and will provide a significant resource for NE Oklahoma, rural, urban and
suburban hospitals, providers, laboratories and pharmacies with best practice for EHR
adoption to facilitate the expansion of HIE. GTHAN will also provide additional insight as
a newly established HIE and collaborative community effort for technology, standards and
best practices for HIE to OHIET.
1.2.1.6. Summary of the Current Gaps in HIE in the State of Oklahoma
With a six year maturation of HIEs in the state, Oklahoma has a very good start on
coverage. Major HIOs are running and exchanging data in most populated parts of the
state. These facilities will be bolstered and improved by the additional funds afforded
them by ARRA. Elements of Stage 1 Meaningful Use will be met by all eligible providers
through existing and planned HIOs and, where broadband coverage is limited, by ASP
models and other functionality made available by SMRTNET. We anticipate no difficulty
in meeting Stage 1 HIE access requirements in FY2011.
OHIET Revised Strategic Plan Page 15
1.2.2. Broadband
The disparity in broadband infrastructure between the urban and rural areas of Oklahoma
is problematic, particularly in areas where bandwidth is unavailable or unaffordable.
Oklahoma has received three grants, through ARRA, that make great headway on bringing
broadband access throughout the state.
The Oklahoma Community Access Network (OCAN) received $74 million to build more
than 1,000 miles of fiber‐optic cable along 13 segments of interstates and highways in 33
counties.
Exhibit 1 – Proposed Broadband Backbone for the State of Oklahoma
An excerpt from the OCAN Executive Summary:
The Oklahoma Community Access Network (OCAN) proposal presents an unprecedented
opportunity for Oklahoma to meet the demands of life in the 21st century. Easy and
reliable access to technology for Oklahomans to travel along the information highway is
as essential in today’s world as the construction of rail was to Oklahoma’s settlement.
OHIET Revised Strategic Plan Page 16
Oklahoma is the 20th largest state in the nation with a population of just over 3.5 million
people. Sixty percent of the population resides in the two metropolitan areas of Tulsa and
Oklahoma City. The remaining forty percent are spread across the state in communities
ranging in size from a few hundred people to 25,000.
The action plan for Oklahoma’s future is focused squarely on today’s knowledge‐based
economy requiring highly educated, technology proficient Oklahomans who can access
and use investments in technology infrastructure to their benefit. With Oklahoma’s
significant rural base across a geographically large area, access to broadband is the key to
growth and prosperity. Creating access to basic services through technology means
Oklahomans in the most remote areas of the state can be in contact with public service
providers, can access distant learning and health care services and can communicate with
their government and one another more readily.
OCAN’s proposal seeks to build 1, 005 miles of new middle‐mile fiber infrastructure to
connect 32 anchor institutions in underserved and unserved areas of the state where a
broadband penetration rate barely reaches 25% in some cases. The fiber route selected
touches 35 of Oklahoma’s 77 counties, approximately 89% of the state’s population, and
is on state highway right‐of‐way. Within five miles of the proposed fiber build are 1,096
schools, libraries, medical or health care providers, public safety entities, community
colleges, institutions of higher education, along with other community support
organizations and government facilities.
OCAN’s middle‐mile infrastructure will support a variety of last‐mile projects of particular
interest to private sector providers who along with local, state and tribal entities have
voiced their support for the project’s goals. OCAN’s impact, as additional fiber
connections are constructed, will mean unprecedented access to essential services for
rural Oklahomans. A number of state agencies own, manage and maintain
telecommunications infrastructures, both wireless and wireline to include the Oklahoma
State Regents for Higher Education, Office of State Finance, Oklahoma Department of
Transportation, and the Oklahoma Turnpike Authority who have worked for over a year
to provide a foundation for OCAN’S application.
OCAN’s grant request is $73,998,268 with a proposed cash and in‐kind match of 20.4%.
OCAN’s proposal will leverage existing state assets with federal funding to address the
great disparity in broadband access between urban and rural areas of Oklahoma.
OCAN principals have more than thirty decades of experience developing and sustaining
public/private partnerships with broadband and telecommunications providers. It is the
goal of the OCAN proposal to expand its partnerships with the commercial provider
community to provide broadband to all areas of the state in the most cost‐effective and
efficient manner possible. In addition to the private providers mentioned specifically in
the application, other partnerships are being pursued and will continue following the
submission of this application. It is anticipated that 863 jobs will be created as a result of
this project.
OHIET Revised Strategic Plan Page 17
Community Anchor Institutions
Miles from Current
Anchor Institution City Backbone Capacity
Community Colleges
Ardmore Higher Education Center Ardmore 6.5 2xFE (200)
Carl Albert State College Poteau 0.2 2xDS3 (90)
Carl Albert State College Sallisaw 0.1 DS3 (45)
Cheyenne and Arapaho Tribal College Weatherford 1
Conners College Warner 2 DS3 (45)
Comanche Nation Tribal College Lawton 1 2xT1 (3)
Eastern Oklahoma State College McAlester 2 DS3 (45)
Eastern Oklahoma State College* Wilburton 0 DS3 (45)
Northern Oklahoma College Enid 2 DS3 (45)
Redlands Community College El Reno 0.7 FE (100)
Seminole State College Seminole 2 DS3 (45)
Western Oklahoma State College Altus 0 DS3 (45)
Health Care/Hospitals
Atoka Memorial Hospital Atoka
Mary Hurley Hospital Coalgate
Choctaw Hospital Hugo
Lawton Indian Hospital Lawton 0
Seiling Municipal Hospital Seiling
Jefferson County Hospital Waurika
Woodward Hospital Woodward
Libraries
Duncan Public Library Duncan 0 1.54 Mbps
Public Safety
DPS ‐ Highway Patrol Troop HQ Durant 0 T1 (1.5)
DPS ‐ Highway Patrol Troop HQ Enid 0 T1 (1.5)
CLEET Ada
Universities
Cameron University Duncan
Cameron University* Lawton
East Central University Ada
Northwestern OSU Enid
Northwestern OSU Woodward
Southeastern OSU* Durant
Southeastern OSU ‐ McCurtain Co. Idabel
Southwestern OSU Sayre
Southwestern OSU* Weatherford
OHIET Revised Strategic Plan Page 18
Additionally, Oklahoma Communication Systems, Inc. (parent company, TDS
Telecommunications Corp.) received $3.5 million from the U.S. Department of
Agriculture, matched by about $1.2 million in private money. The project brings high‐speed
Internet service to residents and businesses near Inola, Bristow, Fletcher and Cyril.
Finally, Pine Telephone Co. received about $9.7 million from the USDA to offer 3G
universal mobile broadband service in Coal, Latimer, Le Flore and Pittsburg counties
within the Choctaw Nation.
OHIET is in contact with the OCAN team and we will work in concert to ensure alignment
of goals and plans. We do not anticipate broadband limitations to impact ability to meet
Stage 1 Meaningful Use or future OHIET goals. We believe the OCAN and other
broadband plans greatly enhance the HIE plans for Oklahoma.
1.2.3. Levels of Technology Development and EHR Adoption in Oklahoma
Oklahoma’s providers and hospitals are in various stages of automation, with larger, more
urban organizations generally having partially or fully implemented EHRs versus smaller
and rural practices and hospitals including Critical Access Hospitals, on the slower end of
adoption. Mid‐sized organizations, such as Federally Qualified Health Centers
(FQHCs)/Rural Health Clinics (RHCs) and multi‐provider groups, fall somewhere in the
middle when using, adopting and implementing EHR/EMR solutions.
Exhibit 2 shows the results of overall EHR adoption among eligible provider groups for
incentive payments.
Exhibit 2 ­Percentage
of Providers Reporting EHR/EMR by Group
Indian Health
Service (IHS)
providers have the
highest rate of
current EHR
adoption of any
provider category
in Oklahoma. IHS
has access to EHR
capabilities through
the federal
Resource and
Patient Management System (RPMS). Of the 475 IHS health professionals that
responded, 88% indicated they had an EHR/EMR.
OHIET Revised Strategic Plan Page 19
Only 23% of the rural hospitals surveyed indicated they had an EHR/EMR. 54% of urban
hospitals surveyed
have an existing
EMR. Of all
surveyed, only 64%
of hospitals
reported having
access to
broadband services
(36% reported no
broadband access).
Exhibit 3 ­Indian
Health Service and Tribal Providers
Regarding Oklahoma’s Community Health Center (CHC) organizations, 15 of 17 (88%)
have implemented an ambulatory EHR; most CHCs currently have broadband service.
The REC, regional HIOs and OHIET are working together to identify and target most needy
areas, set up faculties for guidance and information provision on EHR/EMR, and engineer
a set of solutions to meet Stage 1 Meaningful Use.
1.2.4. E‐prescribing Readiness and Adoption
Electronic prescribing capabilities are growing in Oklahoma. In 2009, according to
SureScripts, 18% of all physicians have systems that allow the routing of prescriptions
electronically and 10% of all prescriptions were routed electronically. Only 3% of patient
visits, however, resulted in a medication history request.
The Oklahoma Pharmacy Association reports that 85‐90% of all pharmacies are currently
capable of accepting electronic prescriptions (corporate pharmacies at 100% while
independent pharmacies are at 75‐80% including rural areas).
OHIET and other state leaders will spearhead activities to drive adoption of e‐prescribing
by all pharmacies statewide.
OHIET has a program to partner with small pharmacies, which may find the start‐up costs
of electronic prescribing prohibitive, that offers a financial incentive program to assist
them with these costs. To drive EHR adoption and create demand for e‐prescribing
capability at the pharmacy level, a collaboration between the Oklahoma Pharmacy
Association, the REC, and State Medical Associations to assist and guide rural providers on
benefits and best practices of EHR. In addition, OHCA (the state Medicaid agency) has
aligned with SureScripts to include in their contracts a requirement that state Medicaid
participating pharmacies participate in electronic prescribing.
OHIET Revised Strategic Plan Page 20
OHIET recognizes that a successful statewide HIE requires complete pharmacy electronic
prescription data and that this is a key component for helping all providers and hospitals
qualify under Meaningful Use. OHIET also recognizes the challenges for electronic
prescribing as they relate to controlled substances and intends to promote the
development of protocols to allow this functionality in a seamless fashion for providers
and pharmacies as these issues are further clarified.
1.2.5. Laboratory Readiness
Another key component of meeting Meaningful Use criteria for providers and hospitals is
the ability to transmit structured lab data. OHIET intends to certify standards by which
laboratory data can pass from HIE to HIE via LOINC coding. Ultimately, success of this
program is contingent upon the thorough adoption of EHR and, as stated elsewhere in
this plan, we will partner with the REC and professional and hospital associations to
ensure the infrastructure and services are adequate to meet Meaningful Use by all
eligible providers. The initial 2011 goal for OHIET will be for laboratory result reporting
with consideration for the submission of laboratory orders in 2013 and beyond.
The analysis of Oklahoma’s current laboratory electronic result reporting is taken from
data collected by SoonerCare. The top 19 paid laboratories by SoonerCare represent 82%
of all SoonerCare dollars paid to labs in 2010. The list follows.
1 DIAGNOSTIC LABORATORY OF OKLAHOMA OKLAHOMA CITY OK 73108 $7,563,764.57
2 OK STATE DEPT OF HLTH PUBLIC HLTH LAB OKLAHOMA CITY OK 73117 $4,322,648.51
3 REGIONAL MED LAB TULSA OK 74114 $3,462,095.35
4 CLINICAL PATHOLOGY LAB AUSTIN TX 78754 $1,582,117.03
5 NATIONAL HLTH LAB DALLAS TX 75230 $1,529,819.42
6 QUEST DIAGNOSTICS CLINICAL LABORATORY
INC
SJ CAPISTRANO CA 92675 $1,318,773.44
7 SAINT FRANCIS OUTREACH SERVICES LLC TULSA OK 74136 $1,066,615.57
8 AMERITOX, LTD MIDLAND TX 79705 $844,472.87
9 PACIFIC TOXICOLOGY LABORATORIES CHATSWORTH CA 91311 $829,815.66
10 QUEST DIAGNOSTICS CLINICAL LABORATORY
INC
IRVING TX 75063 $825,186.80
OHIET Revised Strategic Plan Page 21
11 OUHSC GENETICS LAB OKLAHOMA CITY OK 73104 $645,658.89
12 GENZYME GENETICS SANTA FE NM 87505 $560,186.32
13 GENZYME GENETICS WESTBOROUGH MA 01581 $522,369.12
14 LABORATORY CORPORATION OF AMERICA SAN ANTONIO TX 78213 $504,770.25
15 HEARTLAND PATHOLOGY CONSULTANTS PC EDMOND OK 73034 $430,464.78
16 WINDSOR PARK MEDICAL CLINIC OKLAHOMA CITY OK 73107 $395,238.59
17 MEDICAL DIAGNOSTICS LABORATORIES LLC HAMILTON NJ 08690 $365,380.04
18 BIO REFERENCE LABORATORIES INC ELMWOOD PARK NJ 07407 $355,268.83
19 DIAGNOSTIC PATHOLOGY SERVICES PC OKLAHOMA CITY OK 73112 $344,373.84
$27,469,019.88
OHIET is in the process of confirming the following set of assumptions:
1. This is representative of the pay portions to labs from all major payors in our
state.
2. The 19 labs listed have electronic results reporting capabilities.
3. The remaining 18 to 20% of labs registered in the state are likely draw stations
and small laboratories that have access to electronic resulting via their selected
reference laboratories.
OHIET recognizes the gap in laboratory reporting will be primarily via rural hospital
laboratories including critical access hospitals. The REC and EHR adoption is intended to
help close this gap as well as close partnership with reference laboratories to expend
their electronic/technologic infrastructure to comply with Meaningful Use for all
providers within the state.
OHCA currently requires all laboratories, under contract with their organization, comply
with OHIET and HL7 laboratory reporting standards. It is the intention of OHIET to
partner with private payors, as well, to facilitate the same actions in their contracts with
laboratories.
OHIET Revised Strategic Plan Page 22
1.2.6. Additional Statewide Readiness
OHIET believes EMPI services will be critical to the success of HIE utilization, adoption and
‘network to network’ connections. OHIET is currently working on the feasibility of
providing a statewide EMPI to regional HIEs .
Provider directories present another challenge for Oklahoma as a primarily rural state.
OHIET is presently working on the feasibility of partnering with state HIOs to maintain an
updated and cohesive provider directory. This is a pathway to ensure adequate
electronic exchange, referrals, reporting and messaging to facilitate the highest quality
and the safest patient care.
OHIET has established a working group to define the minimum requirements of a CCD for
HIE and to develop protocols for ‘network of networks’ sharing in order to create
consolidated views for providers and avoid the need for multiple HIE connections.
OHIET is setting up collaborative teams with payor organizations within the state. Key
outcomes of this association are the active participation in the statewide HIE and the
preparation for 2013 and beyond for requirements for electronic eligibility checking and
prior approvals.
OHIET is considering record locator services, credentialing services, public health reporting
services, immunization reporting and consent management services as areas with
potential for leveraged services across the state, overall healthcare cost reduction and as
revenue sources for OHIET.
Other platforms, established by our two state university medical programs and large
hospitals, provide springboards for OHIET. Oklahoma benefits from a well developed set
of telemedicine networks. These networks are operational and provide specialty care to
rural and underserved areas. This infrastructure provides a pathway to further the goals
of OHIET and meet Meaningful Use.
OHIET Revised Strategic Plan Page 23
1.3. Oklahoma’s Strategy for Stage 1 Meaningful Use
Element: E­prescribing
available to all eligible providers
Gap Recognized Strategy Actions Actors
1. There are approx 25%
pharmacies in the state that do
not have e-prescribing
faculties.
2. Rural pharmacies not on board
because they do not have the
‘market pull’ by local providers;
they see no need to undergo
the expense
• Determine areas of greatest need
• Reduce capital requirements
• Create demand from providers to
drive e-prescribing capabilities at
the pharmacy-level
• Create demand from payors at the
pharmacy-level
• Team with small pharmacies and offer financial incentive
programs to assist with start up costs
• Train local providers on benefits of e-prescribing and on
alternatives, i.e., internet prescribing and the advantages to
the end users (patients)
• Develop curriculum to educate end users, providers and
pharmacies
• OHCA and SureScripts have contract req’s for Medicaid
participating pharma’s to provide e-prescribing – leverage
this and encourage other payors to participate similarly
• OHIET/OPA/REC/OSMA
• OHIET/OPA/REC/OSMA
• OHCA/SureScripts/Payor
s
Element: Receipt of structured lab results available to all eligible providers
Gap Recognized Strategy Actions Actors
1. The large labs are in
compliance. For the smaller
labs, especially those
associated with rural providers,
it is unknown.
2. Rewards for MU are not as
apparent for labs
• Focus on laboratory result
reporting first; confirm
capabilities of large labs and
those receiving payment from
largest payors in OK
• Provide incentives to labs
• Demonstrate benefits
• Form team with labs to understand landscape and areas
requiring most intervention
• Create education/awareness campaign with key benefits for
labs and stakeholders
• OHCA requires labs under contract to comply with OHIET
and HL7 lab reporting standards; work with private payors
to develop same
• OHIET/Labs/Payors
• OHIET/REC/HIOs
• OHIET/OHCA/Payors
OHIET Revised Strategic Plan Page 24
Element: Sharing patient care summaries across unaffiliated organizations available to all eligible providers
Gap Recognized Strategy Actions Actors
1. Sharing patient care summaries
will require HIE connectivity to
hospitals and EP’s. Less than
5% of EP’s are live with HIE.
2. HIE Networks will need to share
and combine CCD’s to EP’s on
other HIE networks.
3. EMPI and Provider Registries
will be a rate limiting factor of
cross connections
4. HIPAA and HITECH
Implications of internetwork
connections.
• OHIET will endorse a network of
networks and will support the
existing and new HIE networks
connections to EP’s
• OHIET will collaborate with the
REC and EP’s and MU funding to
support their HIE connectivity
• OHIET will help establish
standards for network to network
connectivity and security
protocols and messaging
protocols consistent with Direct.
• OHIET will work with existing
networks, new networks and
potentially create services for
EMPI and Provider Registries for
the State
• Exploration of DURSA (sp) and
current state HIE legal policies
• Incentive programs for HIE’s and EP’s in areas of low
penetration of HIE. Particularly rural areas.
• Collaboration between the REC and HIE networks to do
support and offerings of HIE with EHR to EP’s.
• Education to EP’s and marketing to EP’s of the benefits and
use case of HIE.
• Establish inter-network HIE connection standards for
security and privacy.
• Assess current EMPI and provider directory services live in
the state as well as proposed solutions to ensure the
success of a network of networks model. Awareness that
OHIET may have to create an add on service to parallel the
network of networks.
• Exploration of current legal and governance agreements,
DURSA and develop a strategy to protect EP’s who have
contributed data to HIE in case of a data breach or end user
misuse of HIE data.
• OHIET
• REC
• Agencies
• Existing Networks
• New Networks
• EP’s
• Medical Associations
OHIET Revised Strategic Plan Page 25
Element: Ensuring broadband access availability
Gap Recognized Strategy Actions Actors
1. 36% hospitals report no access
to broadband
2. Disparity of access to
broadband between rural and
urban parts of state
• Align project with ~$90M ARRA
funds for state broadband
initiatives
• Provide awareness and guidance
to providers/pharma/labs on
EHR/HIE
• Enable work-arounds to areas
without broadband access
• Work with OCAN and others to dovetail technology req’ts
and goals for access throughout the state
• Create consultancy, communications, education to assist
rural constituents
• Team with vendors to create array of solutions for rural
providers
• OHIET/OCAN/OSU/Sec’y
of State
• OHIET/REC/HIOs
• OHIET/Vendor
community
Element: Promoting effective use by all eligible providers
Gap Recognized Strategy Actions Actors
1. 23% of rural and 54% of urban
hospitals have EMR
2. 47% of non-hospital
professionals have EHR
• Create ‘pull’ by providers
• Provide help, guidance and
education to direct users of the
HIE and the end users of
healthcare
• Ensure compliance with state
and fed req’ts that result in
better health outcomes for the
state
• Establish valuable products and services that will be
standardized centrally and made available through local
HIOs: vital stat’s; eMPI; immunization registries, etc.
• Provide continuing incentives for providing by working
with policies and legislation that promote HIE and better
quality health outcomes for the state
• Team with REC, Beacon, universities and others to
provide survey, analysis, education, guidance, etc. to
providers
• Set up clear governance and policies and avenues for
providers to achieve S1 MU and other req’ts
• OHIET/HIOs/vendors
• OHIET/REC/HIOs/Univ/Trainers
• OHIET/REC/legislators
OHIET Revised Strategic Plan Page 26
1.4. Health Information Exchange Coordination Strategies
Coordination of strategies is hardwired with the Oklahoma authority responsible for
Medicaid.
The Oklahoma Health Care Authority (OHCA) is the state’s Medicaid agency and they
were the State Designated Entity (SDE) in the SHIECAP proposal process (prior to OHIET’s
establishment in the 2010 state legislative session) . OHCA has contributed many
resources to the SHIECAP effort from the response to the ARRA FOA to the continued
work in domain areas determining, documenting and implementing the strategic and
operational approaches to a statewide HIE. In parallel process, OHCA staff have authored
and received approval on the State Medicaid HIT Plan (SMHP). This set up has ensured a
dovetailing of strategies between these efforts.
Collaboration will be preserved between OHIET and OHCA in that John Calabro, the
former OHCA Chief Information Officer who co‐chaired the Statewide Oversight
Committee for SHIECAP, was appointed by Governor Henry of Oklahoma as the state’s
first permanent Health Information Technology Coordinator. Mr. Calabro led an effort
that focused on inclusiveness and collaboration of key stakeholders and ensured plans
were coordinated with concurrent activities of HIIAB, Oklahoma’s REC, our Beacon
Community grantee, OKHISPC and others.
Regarding outreach to educate providers on the Medicaid EHR Incentive Program, the
SHIECAP oversight work group coordinated with professional associations such as the
Oklahoma Medical Association, Oklahoma Osteopathic Association, Oklahoma Hospital
Association, Oklahoma Primary Care Association the FQHCs and RHCs, and the REC
through operational provider workshops and quarterly meetings.
Medicare Coordination Along With Other Federal Programs
OHIET and the HIIAB are collaborating to attain widespread use of HIE by healthcare
providers. Through partnerships with the REC, Beacon Community and professional and
hospital organizations, OHIET will align incentives and drive adoption of EHR along with
CMS, Medicaid and other federal programs.
The OHIET ‘network of networks’ will result in an effective statewide HIE that will allow
healthcare providers to exchange clinical information through their local HIEs, such as
medication histories and laboratory results, electronic prescription history and medical
summaries via a CCD at the point‐of‐care, and make better informed decisions with their
patients. These plans will promote and support the effort of eligible professionals who
wish to achieve Meaningful Use.
The planned OHIET ‘network of networks’ will also outline Oklahoma’s current and future
strategies to leverage existing EHR capacity, investment and broad stakeholder
commitment to advance the HIE goals in Oklahoma.
As indicated earlier in the Strategic Plan, the EHR incentive payments for Meaningful Use
are a cornerstone of the Oklahoma HIE initiative and, supporting the ability of Medicare
providers to participate in the Oklahoma EHR Incentives Program is a key objective.
Oklahoma’s environmental scan and results of statewide HIE planning efforts have
OHIET Revised Strategic Plan Page 27
indicated that the inclusion of Medicare data, along with other federal programs in
statewide and interstate HIE, will be critical to the widespread use and sustainability of
HIE in the state.
OHIET will continue to request its federal partners make this data available so that
Oklahoma providers can use the data and achieve Meaningful Use. OHIET is willing to
work with Medicare, IHS, Department of Defense, Veterans Administration, and other
federal programs to create a workable data exchange.
1.5. Domain Area Strategies
1.5.1. Governance
1.5.1.1. Structure to Achieve Results
The Oklahoma Legislature passed Senate Bill 1373 (Appendix 3.2), which Governor Brad
Henry signed into law on June 10, 2010. This legislation expressly approves the creation
of a state‐beneficiary public trust named the Oklahoma Health Information Exchange
Trust (OHIET). The trust has a governing board of seven trustees appointed by state
officials as follows: three by the Governor; two by the Senate; and two by the House of
Representatives. (Trustees are indentified in Exhibit 4.) OHIET is Oklahoma's state
designated entity (SDE) to facilitate and expand the electronic movement and use of
health information among organizations within Oklahoma and to ensure the goals of
SHIECAP station behalf of Oklahoma. An Advisory Board, consisting of representatives
from 18 to 25 organizations, will provide input and support to the board of trustees.
(Exhibit 5, following.)
OHIET recognizes that core infrastructure must be obtained via EHR’s for eligible
providers, hospitals, laboratories and pharmacies in order to facilitate HIE and Meaningful
Use criteria for the state. As previously mentioned in this plan, OHIET intends to promote
the installation and adoption of EHR technology through partnerships with the REC, the
regional HIOs, the university systems and others to provide training, guidance,
consultation and information.
OHIET will assure the development of statewide HIE standards based upon consensus of
local and regional HIOs. In addition, standards will be inclusive of criteria for laboratory
reporting, electronic prescribing and CCD receipt, generation, transfer and re‐generation .
OHIET will monitor compliance with these standards. OHIET will disseminate best
practices, help to ensure understanding of HIE and its policies and work to promote and
sustain electronic HIE within Oklahoma.
OHIET will ensure there are a clear strategic plan and a shared vision for the development
of the statewide collaboration (short‐term and long‐term) and a fair representation of
networks in the statewide governing body – in keeping with the ”network of networks”
model.
OHIET Revised Strategic Plan Page 28
Oklahoma’s Health Information Technology Coordinator also serves as the Executive
Director of OHIET. The State HIT Coordinator, Mr. John Calabro, was appointed by the
Governor Henry. Mr. Calabro sets the charter for the organization as decreed by the
trustees, oversees the daily operations of OHIET, and serves as the public face of the
organization. Mr. Calabro is in process of evaluating additional supporting staff;
budgeted are a Chief Operating Officer, charged with top level management and daily
outcomes in all domain areas, a business analyst to provide data collation, synthesis and
analysis, and executive support. Each domain area is additionally supported by Advisory
Board task forces and by paid industry experts. The Executive Director is an ex‐officio
member of the board of trustees without voting privilege.
Exhibit 4, OHIET Board of Trustees
Trustee Appointer and Term
Robert H. Roswell, MD,
Board Chairman
Gov. Henry
July 31, 2014
Jenny Alexopulos, DO,
Board Vice Chair & Secretary
Rep. Benge
July 31, 2013
Samuel T. Guild
Board Treasurer
Sen. Coffee
July 31, 2012
Julie Cox-Kain Gov. Henry
July 15, 2015
Craig W. Jones Rep. Benge
July 31, 2015
David Kendrick, MD
Sen. Coffee
July 31, 2015
Brian Yeaman, MD
Gov. Henry
July 31, 2011
1.5.1.2. Decision Making Authority
All powers granted to OHIET under the Oklahoma Public Trust Act and other applicable
local, state and federal laws will be exercised by and under the authority of the trustees.
Additionally, the property, business and affairs of OHIET will be managed under the
direction of the trustees in a manner consistent with the trust indenture (Appendix 3.3)
and the bylaws of the trust (Appendix 3.4).
The number of trustees will be seven (7) as prescribed in Oklahoma law. The conduct of
the trust, including specifics of trustee terms, voting requirements, meeting procedures
and so forth are prescribed by the trust indenture.
OHIET will have an Advisory Board to provide representation of major constituencies
served and to assist in the activities of the trust (Exhibit 5). Recommendations from the
Advisory Board will be presented as an agenda item at a duly called meeting. The
OHIET Revised Strategic Plan Page 29
trustees will give deference to and due consideration of the recommendations of the
Advisory Board. The Advisory Board also will perform such other functions as may be
directed by the trustees in connection with or in furtherance of OHIET.
Subject to the approval of the trustees, the Advisory Board will be entitled to establish
rules, regulations, policies and procedures relating to its operation, and standing and ad
hoc committees and workgroups, in furtherance of its functions.
1.5.1.3. Set Up and Membership Representation
OHIET trustees will have a working knowledge of HIE and background in health care.
The OHIET Advisory Board provides broad stakeholder representation to the organization
and will be composed of not fewer than 17 nor more than 25 persons including, at a
minimum, one representative from each of the following:
Exhibit 5 ­Advisory
Board Member Organizations
1. Oklahoma Health Care Authority [Medicaid], Lynn Puckett, Director Contract Services
2. Oklahoma State Department of Health [Public Health], Rebecca Moore
3. Oklahoma Department of Mental Health and Substance Abuse Services, Terri White, OK Sec’y of
Health
4. University of Oklahoma Health Sciences Center, Kevin Elledge, ED of Ops
5. Oklahoma State University Center for Health Sciences, Dr. James Hess, COO
6. A nominee of the Indian Health Service Office responsible for Oklahoma, Dr. Farris, CMO
7. A representative of Tribal interests, Mitch Thornbrugh, Cherokee Nation
8. Oklahoma Hospital Association, Rick Snyder, COO
9. Oklahoma Osteopathic Association, Dennis Carter, DO
10. Oklahoma Pharmacy Association, Jim Spoon
11. Oklahoma State Medical Association, Dr. Kent T. King
12. Oklahoma State Chamber of Commerce, Matt Robison, VP Small Business & Workforce
Development
13. Security and privacy representative nominated by the Oklahoma Health Information Security and
Privacy Council, Robn Green, OSDH and Vice Chair of OKHISPC
14. A HIE representative as nominated by the OHIET Board, Joseph Walker, Greater THAN
15. A consumer appointed by the Governor, pending
16. A nominee of the Oklahoma Regional Extension Center steering committee, Jonathan Kolarik,
RN, Director of HIT
17. Oklahoma Association of Health Plans, Bill Hancock, VP & GM, CommunityCare Managed Health
Plan
18. Representative of Oklahoma rural providers, Val Schott, Oklahoma State University
19. A second HIE representative as nominated by the OHIET Board, Mark Jones, SMRTNET
Representation from up to six additional organizations
OHIET Revised Strategic Plan Page 30
The trustee board may add up to eight additional memberships to the Advisory Board,
from what is described in the trust indenture, as need for additional expertise and
representation becomes evident. One representative of rural providers and one
additional representative of HIE expertise have been added to the original 17 named in
the indenture.
1.5.1.4. Oklahoma HIT Coordinator
The Oklahoma HIT Coordinator (HITC) exists to provide leadership, direction,
management and coordination of HIT strategy for the state of Oklahoma, which includes
the implementation of federal and state requirements for HIT and HIE efforts. The HITC
works cooperatively with multiple stakeholders, including healthcare providers, health
plans, health profession schools, consumers, technology vendors, public health agencies
and healthcare purchasers to identify existing resources, needs, commonalities of interest
and project priority. Additionally, the Oklahoma HITC manages the plan that prescribes
activities necessary to facilitate and expand the electronic movement and use of health
information among organizations consistent with both state and federal HIT strategic
plans.
Oklahoma’s HITC also serves as the Executive Director of OHIET and he must carry out the
responsibilities of this position along with the other duties of HITC. (Appendix 3.5 –
Oklahoma HIT Coordinator Position Description used to guide the selection team in the
process of identifying and choosing the office holder.) John Calabro, former CIO of OHCA,
was selected and appointed by Governor Brad Henry as Oklahoma’s first permanent HIT
Coordinator. Mr. Calabro took office on December 1, 2010.
1.5.1.5. Alignment with Nationwide Health Information Network (NHIN) Governance
OHIET‘s governance model is designed to be compatible with emerging NHIN governance
principles and functions. A pathway to Stage 1 Meaningful Use compliance is OHIET
becoming the certifying authority of HIE in Oklahoma. Alignment with NHIN governance
is designed as part of this certification process. In further compliance with developing
policies and procedures from NHIN and ONCHIT, OHIET and our partners have planned
curriculum and guidance to assist providers with both. Should entities fall outside of the
OHIET network of networks, alignment directly with NHIN is Oklahoma’s strategy for
Stage 1 Meaningful Use.
1.5.1.6. Alignment with State Medicaid Hit Plan (SMHP)
This Strategic Plan, as well as the Operational Plan, under separate cover, are written in
coordination with the initiatives set forth on the SMHP by the Medicaid agency, OHCA.
The OHCA Chief Information Officer, Mr. John Calabro, (Mr. Calabro is now the appointed
OHIET Revised Strategic Plan Page 31
State HIT Coordinator for Oklahoma) co‐chaired the Statewide Oversight Committee for
the SHIECAP, and OHCA staff members participate on each of the domain area
workgroups to ensure coordination of planning efforts. Emphasis is placed on
collaboration of stakeholders and coordination of activities. This plan and the operational
plan were developed for OHIET, by representatives from the Health Information and
Infrastructure Advisory Board, Oklahoma’s Regional Extension Center, Beacon grant
awardee, the Oklahoma Regional Extension Center, and key stakeholders throughout the
state of Oklahoma. (A full list can be seen in Appendix 3.8).
Outreach to educate providers on the Medicaid EHR Incentive Program was coordinated
with professional associations such as the Oklahoma Medical Association, Oklahoma
Hospital Association, Oklahoma Primary Care Association, the FQHCs and RHCs, and the
REC through operational provider workshops and quarterly meetings to educate
providers and minimize duplication of efforts.
Collaboration with OHCA to assist providers in meeting Stage 1 Meaningful Use include
contract provisions, set out by OHCA, with pharmacies, labs, and providers that enforce
use of the OHIET network of networks.
1.5.1.7. Standards
OHIET’s execution strategy is around development and promulgation of standards within
the state in the following four, key areas:
1. Develop a process for evaluating and certifying health information organizations to
ensure that every region of the state is served by a high‐quality health information
exchange. Areas of focus for this activity will include, but not be limited to, evaluation
of governance, technology, privacy and security policies and capabilities, and financial
stability.
2. Consider, plan and implement services and technologies that are best suited to
centralized, statewide implementation, in support of the network of health
information organizations in the state. Areas of focus for this activity may include:
a. Establishment of a statewide policy for privacy and security;
b. Provision of electronic master indices services for person/provider/patient;
c. Development of state agency data services (i.e., Immunization registry, vital
statistics, etc.) to support all certified HIOs;
d. The creation of a process and/or technology to enable statewide reporting of
health and healthcare system outcome metrics from the network of HIE
networks; and
e. The potential establishment and oversight of a ‘health benefits exchange’ for
the state.
3. Identify and assemble policy and statutory changes needed to support ongoing,
appropriate, and secure health information exchange in Oklahoma and provide
information and support as needed throughout the legislative, executive, and judicial
processes required to achieve these changes.
OHIET Revised Strategic Plan Page 32
4. Interact and coordinate with equivalent organizations and leadership in neighboring
states and regions, as well as the NHIN to ensure the seamless exchange of
appropriate health information for patients receiving care in multiple states or
regions.
1.5.1.8. Accountability and Transparency
OHIET will employ rigorous accountability and transparency practices that include at least
monthly status reports to the board of trustees and to the public. The trust is subject to
the Open Meetings Act and adheres to the specific requirements therein. OHIET’s
website, www.ohiet.org provides an outlet for public review and input.
Financial accountability and transparency practices are set through the public sector and
rule‐making authority of OHIET, as well as the contractual requirements of the Office of
the National Coordinator of Health Information Technology (ONCHIT) and ARRA. OHIET’s
board of trustees has financial oversight of the organization and is led by treasurer, Sam
Guild.
Regional and local HIEs will be held accountable for appropriate implementation of HIE
practices through certification and accreditation policies of the governance entity. OHIET
vendor contracts articulate accountability and transparency requirements.
1.5.1.9. Continued Opportunities for Improvement
It is critical that all stakeholders have a place at the table in shaping HIE policy in
Oklahoma. Experience of the REC, Beacon, existing HIOs, pharmacies, laboratories,
hospitals and physicians enhance the success of OHIET. These entities participated and
strengthened the work done in the SHIECAP process to date through the oversight work
group, task forces in each domain area, and formally through other forums and informally
through each member of the large team. As OHIET evolves, it will strive to continually
take on new challenges to prepare the stakeholders within the state for later phases of
Meaningful Use and become more skilled at optimizing input from valued stakeholders.
OHIET seeks continued input through its advisory board, its consultants and through new
channels including the OHIET website and the many planned outreach programs of OHIET
and its partners.
1.5.2. Finance
1.5.2.1. Business Model
To further the efforts of OHIET, the trust will establish a budget in line with our four areas
of strategic execution, and specifically how these elements work toward meeting Stage 1
Meaningful Use across the state and set up for further meaningful use criteria:
OHIET Revised Strategic Plan Page 33
1. Evaluate and certify regional HIOs to ensure that all parts of the state are served by a
high quality HIE.
2. Develop and implement services and technologies that are best suited to centralized,
statewide implementation.
3. Identify and assemble policy and statutory changes needed to support ongoing,
appropriate, and secure health information exchange in Oklahoma.
4. Interact and coordinate with HIEs in neighboring states and regions, as well as the
Direct Project.
Key budget categories, in order to conduct OHIET business, include:
1. Human resources and support:
OHIET plans a skeletal staff, led by the Executive Director and supported by a
COO and analysts; overhead for these individuals is kept to a minimum, using
donated office space and services where possible.
They will be aided by legal, business, and domain area consultants to assist in
professional execution of OHIET work.
Financial management, oversight and reporting are required.
It is anticipated that Advisory Board committees and Trustees will provide
critical support in all these areas, allowing minimal levels of staffing in each to
accomplish OHIET business.
2. Service and technology development:
The assessment and development of products and services that would benefit
the state and the regional HIOs to centralize. This may include master indices,
data registries and vital statistics, reporting and metrics tools, etc. Focus will
be on elements that encourage and stimulate the adoption of use of the
HIOs/HIE.
3. HIE/HIO development:
Closing gaps to meet Meaningful Use includes elements from partnering with
other organizations to provide education, training and consulting services to
eligible providers, to providing financial incentives to outlying cases where the
benefits of the HIO/HIE are not immediate (i.e., in rural and/or under‐privileged
areas of the state).
4. Advocacy and policy:
Develop of policy for certification and compliance with OHIET and ONCHIT
criteria to advocacy and policy development in the legislative arena are
required for OHIET’s present and future success.
In addition to the requirements set out by SHIECAP and ONCHIT, OHIET understands the
need to generate funds at least equal those required for federal matching dollars in initial
years of operations and to then be in a position to maintain the operation and
administration of the “network of networks” in the future. This strategy is designed to
accomplish both. OHIET will build ‘value add’ products and services with an eye toward
market desirability in order to generate required revenues and become self‐sustaining.
OHIET Revised Strategic Plan Page 34
FFY 2010 began October 1, 2009.
The bulk of FFY2011 dollars will go toward ensuring Oklahoma meets Stage 1 Meaningful
Use criteria. Budget details are included in the Operational Plan, Section 2.
The establishment of statewide HIE, where every hospital and healthcare provider has
access to patient information at the point‐of‐care will cost well beyond the funding
available through this grant funding. OHIET will strive to catalyze and promote ways,
through existing, planned and future local/regional HIOs, to accomplish this ambitious
goal.
1.5.2.2. Approach to Sustainability
The federal stimulus funding is designed to last four years, at which time the Office of the
National Coordinator will hold HIEs accountable for sustainable revenue generating
business models. The HIE business models will need to deliver value to a wide variety of
stakeholders.
Several sustainability models have been considered. Because OHIET is a “network of
networks” model, customers are the state’s local and regional HIEs. Several discussions
between OHIET and representatives from planned and existing HIEs have given rise to
many ideas for value added products and services OHIET might provide for fees. Initially,
OHIET plans to provide credentialing and certification services for fees to HIOs. Ancillary
services to these, such as consultation, data sharing, etc., have revenue potential as well.
Moving beyond the first few years and as the relationships between OHIET and regional
HIEs mature, sustainability models will be designed to continually work toward raising
patient care, ensuring efficiencies, and continuing to meet state and federal goals.
1.5.3. Technical Infrastructure
1.5.3.1. Interoperability
1.5.3.1.1. NHIN Connectivity
OHIET’s interoperability strategy is to facilitate and promote connectivity across the state
and also to neighboring states via NHIN. This ”network of networks” model provides
flexibility for providers, facilities and other health‐related workers to join a network that
bests suits their geographical location, referral patterns and business model while
maximizing the ability to connect systems.
OHIET Revised Strategic Plan Page 35
OHIET will assist in the creation of HIE processes that will accommodate both federated
and centralized data connections across the state. At this time, Oklahoma intends to
federate to bordering states and the NHIN. NHIN connectivity will be prioritized as the
national effort moves forward and OHIET includes NHIN standards in certification criteria
for HIE networks.
1.5.3.1.2. Standards Adoption
OHIET’s bylaws (Appendix 3.4) establish the trust as the standard‐setting body for
Oklahoma’s statewide HIE effort. Oklahoma will adopt ONC standards and HIE
certification criteria. OHIET will facilitate the collaboration of state HIEs to determine and
develop HIE standards for the state. All entities connecting to OHIET must pass a
certification process. OHIET will assist in the streamlining of the certification process for
qualified, eligible parties.
1.5.3.2. Enabling Meaningful Use in Oklahoma
OHIET will assist providers in meeting all stages of Meaningful Use criteria. A summary of
our plan to help meet Stage 1 Meaningful Use appears in Section 1.3. OHIET recognizes
the criticality of meeting these goals by end of fiscal year 2011 and is directing all actions
toward this outcome.
Similar plans and operations for meeting goals will be developed as further stages of
Meaningful Use are defined by ONCHIT.
1.5.3.3. Approach to Technical Architecture “Network of Networks” Model
Oklahoma’s statewide HIE technical architecture strategy proposes a federated network
model and contemplates a consolidated statewide Enterprise Master Patient Index
(eMPI) and record locator service. The federated network creates the connection for the
”network of networks” approach adopted by Oklahoma. HIE networks will interconnect
to form the statewide HIE, excepting IHS participants and tribal entities (who have
established connection with NHIN and will maintain statewide connectivity via NHIN).
OHIET services will be those that are leveraged by centrality of ownership, location,
purchasing power, etc., to the benefit and use of the local HIEs. This model will be cost
effective without recreating a large centralized infrastructure or duplicating costs and
efforts of local HIEs. In addition, this will enhance OHIET’s sustainability by making it a
value‐add, low cost organization. IHS and tribal entities may either connect directly or
through a local network.
OHIET Revised Strategic Plan Page 36
Exhibit 6: Oklahoma Statewide HIE Logical Architecture
OHIET Revised Strategic Plan Page 37
Exhibit 6 depicts the Oklahoma logical statewide HIE technical approach. Networks, IHS
and tribal entities will need to be certified before exchanging live data through the
statewide network. OHIET will work to assist in timely certification of all participants
wanting to use the network.
The payors and state agencies will be encouraged to enhance their infrastructure to
connect to state HIE to perform payor‐related tasks not associated with direct clinical
care of patients. These tasks include electronic claims transactions, eligibility checking
and quality reporting. OHIET will facilitate connections with the payors and state
agencies for these functions.
1.5.3.4. Health Information Technology Components
1.5.3.4.1. Electronic Health Records (EHR)
Any EHR in the state of Oklahoma will be required to adhere to national standards,
including CCD exchange capabilities. All EHRs connected to OHIET must also adhere to
policies of privacy and security, data integrity and so forth as promulgated by OHIET.
OHIET reserves the right to remove EHRs that do not meet these requirements from the
state program.
OHIET’s role is to ascertain adoption rates and processes of state providers; identify gaps
in uptake and analyze data that lead to patterns; work with state partners and national
best practices to establish an array of solutions that will lead to meeting ONCHIT and
Meaningful Use criteria; determine roles in implementing solutions and how best OHIET
can participate; monitor closely and measure outcomes; adjust until goals are realized.
1.5.3.4.2. eMPI
The eMPI is a key component of the statewide HIE. The statewide HIE strategy to enable
cross‐network identity management is a pivotal goal for the statewide effort. Tracking
patients across networks of care, state lines and the nation to provide a continuum of
care is critical to providing patient‐centered care.
OHIET is central to establishing an eMPI for the state. At present, OHIET is working on
acquiring the bases for this data and a path to complementing it and making it available
statewide.
1.5.3.4.3. Scalability
The Oklahoma HIE strategy positions itself for future growth. Initial goals are to bolster
EHR adoption, core systems in laboratories and pharmacies and connect existing and
planned networks. This will promote use by providers seeking to achieve and
demonstrate Meaningful Use and ensure that valuable and needed data is available at the
point of care. Scalability is an important factor in meeting OHIET goals to ultimately see
HIE coverage over the entire state.
OHIET Revised Strategic Plan Page 38
OHIET���s role will be to ensure Phase 1 Meaningful Use requirements are met and then to
continue to focus on necessary elements to be required in phases 2 and 3 of Meaningful
Use, such as electronic eligibility checking, credentialing, and electronic order submission.
1.5.3.4.4. Public Health Technology
The Oklahoma State Department of Health (OSDH) is in the process of planning,
designing, developing, upgrading and expanding OSDH systems to allow EHR entities to
meet Stage 1 Meaningful Use criteria (capability for OSDH to be able to accept EHR
immunization data and verify that the Immunization electronic data submission is
successful) and Stages 2 and 3 criteria and timeframes when defined.
Specific OSDH projects have been initiated to upgrade both the Oklahoma State
Immunization Information System (OSIIS) and Laboratory Information Management
System (LIMS).
Development of an OSIIS replacement is underway to modernize the system to meet
industry best practices as well as conversion of the system to Microsoft .NET and SQL
Server technologies.
The completed OSIIS product will include an Unsolicited Vaccination Update (VXU)
database repository that is envisioned to serve as the primary repository for incoming
and future (Stage 2) outgoing Health Level Seven (HL7) messages (current projection is
HL7 V2.5.1). Stage 3 meaningful use requirements are unknown at this time.
OSDH is currently compiling information from larger Oklahoma related EHR’s and entities
for prioritization in establishing and testing standardized processes for data import into
the VXU repository. Multiple interoperability prototype projects with messaging
partners are under discussion and consideration. Among these is a prototype project with
VisionShare (now ABILITY) to receive Immunization VXU messages via DIRECT from EHRs
and forward to OSDH using PHINMS transport. This enables Immunization messaging to
OSDH via PHINMS or DIRECT.
A Request for Proposal (RFP) for the OSDH LIMS has been developed that includes
primary deliverables of HL7 accessioning, results reporting, and data repository
interfaces. The RFP is currently transitioning through the procurement process.
Simultaneous to OSIIS and LIMS development, the OSDH is proceeding with the
development and incorporation of an internal Enterprise Master Person Index (eMPI)
necessary to achieve interoperability between both internal and external systems. The
eMPI project is currently focusing on the linkage of OSDH systems including OSIIS, Vital
Records, Public Health Client Information System (PHOCIS), and other key databases and
registries of the agency. The development of an agency eMPI is considered a priority
need in assuring the OSDH can meet expected requirements for Stages 2 and 3
Meaningful Use criteria and to interact with the HIE.
OHIET Revised Strategic Plan Page 39
1.5.3.4.5. Broadband
The current status of broadband in Oklahoma is as described in Section 1.2.2 in the
Environmental Scan. Access to broadband throughout the state is a concern and OHIET is
working with the Secretary of State, Susan Savage, who leads the Oklahoma Community
Access Network (OCAN) effort to build a fiber backbone to reach across the state. In the
meantime, OHIET is working to identify feasible work‐around models that will allow
eligible providers to meet Stage 1 Meaningful Use this year. These include ASP models
and other technologies currently tested and in use in the state through SMRTNET and
others.
1.5.3.5. Approach to Clinical and Quality Assurance Measures
OHIET will regularly collect, report and monitor a set of performance measures to
accurately track the Oklahoma HIE effort and assess readiness for new phases of work. In
addition to the required measurements, OHIET will use the existing Physician Quality
Reporting Initiative (PQRI) model with de‐identified patient information and adapt it to
meet Meaningful Use criteria and requirements.
OHIET will conduct clinical and quality assurance surveys to establish baselines statistics
and update annually to capture changes over time. The planned tasks are:
• Define clinical user specifications, including data sharing requirements, data use
agreements and policies, quality‐related technology requirements, and data
access standards;
• Assist in data collection with state Medicaid and CMS for attestation and
verification of Meaningful Use by hospitals and eligible providers;
• Compile performance and evaluation metrics identified by the task forces;
• Identify best practice case studies;
• Determine performance specifications and set quality standards and goals;
• Generate strategies for incorporating best practices, lessons learned and
continuous improvement efforts;
• Create a plan, in conjunction with the REC, Beacon, existing HIOs and
organizations with high levels of adoption of EHR and HIE for dissemination of best
practices and knowledge transfer of strategies for current and future
implementations and security and protection of data;
• Highlight areas of non‐performance or under‐performance and provide analysis
on trends, exceptions, etc.
Peformance metrics and methodologies for obtaining, analyzing and reporting are
discussed in OHIET’s Operational Plan, Section 2.
OHIET Revised Strategic Plan Page 40
1.5.4. Business and Technical Operations
1.5.4.1. Implementation
The OHIET Operational Plan (Section 2) provides the particulars of implementation of the
work of OHIET. Executive oversight is provided to the organization by the seven‐member
board of trustees. Trustees have impressive records and knowledge of HIE and the health
care industry and provide perspective of clinicians, academics, hospitals, payors, IT
professionals, state agencies, regional HIEs, urban and rural settings (please see Exhibit
4). Daily operations of OHIET is performed by OHIET staff: the Executive Director, John
Calabro (also the state HIT Coordinator); the Chief Operating Officer and an analyst, both
to be named. These three individuals oversee operations conducted in each of the
domain areas, with assistance from vendors and consultants. Procurement and
contracting procedures to engage domain expertise have been established by the trust,
and follow state and federal guidelines.
OHIET benefits from the Advisory Board. An 18‐member Advisory Board has been
identified in the trust indenture (Appendix 3.3 and Exhibit 5) and an additional seven
member organizations are allowed. The Advisory Board provides representation from
healthcare providers, including those that serve low income and underserved populations
as well as from rural areas, health plans, patient or consumer organizations that
represent the population to be served, HIT vendors, health care purchasers and
employers, public health agencies, health profession schools, universities and colleges,
clinical researchers and other users of HIT such as the support and clerical staff of
providers and others involved in the care coordination of patients. The Advisory Board is
meant to advise the Board of Trustees as well as augment OHIET staff in each domain
area in the implementation phase of this work. Advisory Board members are individuals
who enjoy the concurrence on recommendations for their respective organizations. An
impressive group of individuals, many Advisory Board members have been advising and
working on domain task forces in order to inform this and the operational plan. A list of
these representatives is given in Appendix 3.8.
1.5.4.2. Project Management
Classic project management tools and approaches are in use to implement OHIET
business and conduct project work. OHIET employs individuals who have been trained
and have deep experience in the arena of project management. Project tracking tools
include scheduling, cost accounting, reporting on project progress, communications,
meeting minutes, assigned responsibilities and so on. Project management extends to
procurement in project estimating, vendor identification, due diligence, creation of bid
packages, vendor selection, contracting and contract management and oversight as well
as performance evaluation by working with vendors to take and report out specific
project metrics and to oversee remediation when metrics indicate intervention. It
extends to accounts payable by approving invoices and providing parallel tracking of work
progress to that of vendors.
OHIET Revised Strategic Plan Page 41
Quality control and assurance are key deliverables by the project management team.
Final deliverables include work conducted professionally, in keeping with the tone and
tenor of ONCHIT, on time, on or under budget and of the highest caliber.
Project management philosophy is ‘by exception’, enabling streamlining of information
for executive staff and boards. Working meetings keep running minutes of assigned tasks
with due dates and current status. Goals are established for each task force. Escalation
processes are established in line with goals. Tracked tasks and issues are escalated
according to an agreed process.
1.5.4.3. Leveraging Existing HIE Capacities and Services
OHIET services will be leveraged through existing HIOs. Multiple regional HIE efforts have
or will have HIE capacities that can be shared with the statewide effort: eMPI, e‐Rx,
immunization data, labs, prescriptions, patient look‐up, patient demographics, Record
Locator Services (RLSs) exist in current networks within the state. These services of
existing HIOs will be expanded upon to facilitate the network of networks that will form
OHIET. Alternatively, OHIET may choose to engage in new technology or other
partnerships to provide additional or extended services. Services or capabilities for the
statewide HIE will be competitively bid to take advantage of existing efforts and
economies of scale. This will facilitate a cost‐effective model without recreating a large
centralized infrastructure and duplicating costs and efforts of the existing HIOs. In
addition, this will ensure that OHIET is a sustainable organization with low, long‐term
operational costs.
1.5.4.4. Communications, Education and Marketing (CEM) Strategy
The purpose of the CEM strategy is twofold:
1. To inform, educate and engage health care providers and organizations, the
public, and other key stakeholders about the benefits of HIT adoption and use,
and HIE‐related activities in Oklahoma; and
2. To engage key stakeholder organizations that will be instrumental in helping
communicate important information to their members and constituents, and
assisting with these activities.
HIE, HIT, EHR, etc., are confusing topics to even the initiated users of such services.
Coupled with the myths and misinformation about any emerging technologies or services
as well as the confounding elements of healthcare and its ancillary services and the
landscape becomes ripe for confusion very quickly. De‐mystifying HIE and HIT and
articulating end user benefits to a widely segregated market space of direct and indirect
users are the key tasks in the CEM strategy.
Topics of the plan include:
OHIET Revised Strategic Plan Page 42
1. Overarching themes that describe and define OHIET; these include key values,
priority goals, overall mission, etc., and will result in branding, image, and
architecture for OHIET messaging.
2. Prioritization of effort aligned with ONCHIT and Meaningful Use goals that are the
initial focus of OHIET and a plan to provide CEM to critical areas; this will include
targeted communications, public awareness and education to groups essential to
achieving Stage 1 Meaningful Use criteria, and then to subsequent initiatives
critical to meet the goals and purpose of OHIET.
3. Development of materials to accomplish content of topics 1 and 2; this will include
communications packages, image and content for all media, website and user
interface, educational materials, and marketing collateral; each targeted to
specific market segments.
Generally, the project relies on current ongoing communication activities that have
proved to be successful in making information about HIE in Oklahoma available and
accessible to stakeholders in the health community. These activities play an important
role in the overall communications strategy for this project are selected and employed on
an “as needed” basis. Written presentations, meeting minutes, and other materials are
available on the OHIET website. An important element of OHIET is the ability to
collaborate; this extends to the CEM effort as well. Best practices and partnerships are
leveraged to garner the highest efficiencies in connecting with target audiences. OHIET
has already successfully collaborated with organizations such as the Oklahoma Hospital
Association (OHA), Oklahoma State Medical Association (OSMA), and the Oklahoma
Osteopathic Association (OOA) to communicate important information to providers about
HIT and HIE. Coordination of education and public awareness campaigns with the REC,
OSU and others targeting special needs populations (including work force and training
facilities) is woven into the plan. As borne out by the environmental scan, the rural areas
and the unaffiliated organizations will be priority targets in order to achieve Stage 1
Meaningful Use.
Interviews of CEM consultants have already resulted in discussions of key messages and
communications required to target a multiple segment marketplace. Communications
and education are tailored to various stakeholder audiences including Information
technology, including professional and social networking sites, are to be incorporated to
gain efficiencies and reach a broader audience, wherever possible. This aligns with
methods for information dissemination and modalities to adequately ‘connect’ with the
desired audiences including a general audience, policymakers, Oklahoma legislators,
health plans, hospitals, long‐term care, home health, physician organizations, community
clinics, public health departments, local Regional Health Information Organizations
(RHIOs), ancillary service organizations (i.e., lab, pharmacy, imaging), vendors, the public,
consumer advocates, health care payors, purchasers and employers.
Coordinated messaging with other key groups in the state who are providing public and
targeted outreach including the local HIOs, the REC, the colleges and universities and
various other groups is in the plan. Also included are activities aimed at broadening
existing collaborations to include additional health care organizations, providers and
consumers.
OHIET Revised Strategic Plan Page 43
OHIET has a value added role to play in the CEM efforts in the state. This is an
appropriate ‘central’ role where the investment will be leveraged across the state. The
plan centers on working with the regional HIOs and helping them drive the messages and
awareness required for their success.
1.5.5. Legal / Policy
1.5.5.1. Privacy and Security
Oklahoma Privacy and Security Landscape
Oklahoma generally adheres to Health Insurance Portability and Accountability Act
(HIPAA) and 42 C.F.R. Part 2 standards for use and disclosure of protected health
information (PHI), with limited exceptions for certain classes of information. Hence,
Oklahoma usually does not require authorization for exchange of Protected Health
Information (PHI) for purposes of payment, treatment or health care operations.
Examples of instances where Oklahoma may require authorization for exchange include
records containing substance abuse information,2 reportable communicable or non‐communicable
disease information,3 and certain information concerning minors.4 In
these instances, disclosure requires either authorization or additional notice concerning
the nature of records subject to disclosure.
Like other states, Oklahoma's privacy laws present some barriers to both intra‐state and
inter‐state exchange by imposing heightened requirements on certain disclosures.
Stakeholders from Oklahoma's health care community, however, have actively worked to
reduce such impediments. As participants in the HISPC process, these stakeholders
studied how to improve the state's privacy laws in order to promote secure and efficient
HIE. The HISPC process presently continues, with the initial federally‐sponsored
collaborative now functioning as a state council (OKHISPC) under a 2008 executive order
issued by Oklahoma Governor Brad Henry.
Oklahoma Health Information Exchange Legislation
To date, Oklahoma's HISPC efforts have already resulted in successful enactment of two
laws that have improved HIE in the state.
First, the HISPC collaborative worked with the Oklahoma legislature in 2007 to pass the
Oklahoma Health Information Exchange Act.5 The Act directed the Oklahoma
Department of Health to adopt and promulgate a uniform authorization for the exchange
of health information that complies with both federal and state privacy law. (Appendix
2 See 43A O.S. § 1‐109.
3 See 63 O.S. § 1‐502.2.
4 See 63 O.S. § 2602.
5 See 63 O.S. §§ 7100.1‐7100.7.
OHIET Revised Strategic Plan Page 44
3.10) The Authorization, and related patient and provider instructions, expressly sets
forth the instances where Oklahoma requires authorization for exchange and makes clear
Oklahoma does not generally require authorization for purposes of payment, treatment
and health care operations.
Second, OKHISPC worked with the Oklahoma legislature in 2008 to amend the state's
patient‐physician/psychotherapist privilege to clarify the privilege does not prohibit
disclosures of protected health information otherwise permitted under state and federal
privacy law.6
OKHISPC continues to study future opportunities to foster HIE. Further, many of
Oklahoma's HISPC council and collaborative stakeholders will also have an active role in
connection with OHIET's efforts to similarly promote HIE.
Privacy and Security Under OHIET
As further set out in Sections 1.5.5.2 through 1.5.5.5 below, OHIET will specifically require
compliance with applicable state and federal privacy laws as an express condition under
the trust agreements governing participation in the exchange. By incorporating and
applying these statutory and regulatory provisions, OHIET will clearly reference the
standards by which participants must conduct HIE.
HHS Privacy and Security Framework:
OHIET will achieve, in significant part, the eight objectives of the HHS Privacy and Security
Framework through similarly incorporating aspects of these objectives as conditions for
participation under trust agreements with exchange participants.
Individual Access:
The OHIET trust agreement will foster individual access to personal health information by
requiring exchange participants to provide access to individual records and disclosure
accounting in accordance with the Privacy Rule7 and the HITECH Act.8 Exchange
participants may provide access through a number of means, including but not limited to:
a secure web‐portal, personal health records, or direct provision of information by the
exchange participant to the individual or the individual's designee. Exchange participants
will be responsible for putting measures in place to secure the authentication of the
individual requesting access to information.
Correction:
The OHIET trust agreement will require exchange participants to comply with the Privacy
Rule9 and provide individuals with the opportunity to request corrections to PHI
generated or maintained by the exchange participant. OHIET anticipates the agreement
will also contain additional language concerning the specific manner in which exchange
6 See 12 O.S. § 2503(D)(5).
7 See 45 C.F.R. § 164.524.
8 See 42 U.S.C. § 17935(e).
9 See 45 C.F.R. § 164.526
OHIET Revised Strategic Plan Page 45
participants must provide notice and documentation of disputed information in
connection with disclosures.
Openness and Transparency:
From an organizational standpoint, Oklahoma selected the state‐beneficiary public trust
as the structure for OHIET in large part due to the inherent openness and transparency of
such entities. Oklahoma permits the creation of state‐beneficiary public trusts that
operate for the express benefit of the state and its citizens. Oklahoma law requires such
entities comply with the Oklahoma's Open Meetings Act,10 Open Records Act,11
Administrative Procedures Act,12 Public Competitive Bidding Act,13 and Public Trust
Competitive Bidding requirements.14 These acts will ensure public access and opportunity
for input and involvement in OHIET's efforts to foster HIE in Oklahoma.
From an operational standpoint, OHIET will also encourage exchange participants to
exhibit similar openness and transparency concerning participation in the exchange.
Specifically, the OHIET trust agreement will recommend exchange participants provide
patients and consumers with clear notice, preferably via the participant's Notice of
Privacy Practices, regarding how the participant will use and disclose information through
the exchange; the choices the individual may exercise with respect to the information
(e.g., access15, accounting of disclosures16, request for restriction17); and the privacy and
security measures applied to safeguard such data.
Individual Choice:
OHIET will adopt a consent model that allows for exchange of protected health
information amongst participants, in accordance with minimal necessary requirements of
the Privacy Rule18, in all instances where federal and/or state law permit disclosure
absent authorization. As noted above, exchange participants should provide individuals
with clear notice concerning these uses and disclosures through the exchange; instances
where individual authorization is necessary; and the choices individuals may exercise with
respect to protected health information.
Collection, Use, and Disclosure Limitation:
OHIET trust agreements will expressly require exchange participants to adhere to the
minimum necessary requirements of the Privacy Rule19 to govern the collection, use and
disclosure of information amongst exchange participants. Subject to such requirements,
the trust agreements will permit exchange participants to use, collect and disclose
10 See 25 O.S. §§ 3101‐312.
11 See 51 O.S. §§ 24A.1‐24A.29.
12 See 75 O.S. §§ 250‐323.
13 See 61 O.S. §§ 101‐138.
14 See 60 O.S. § 176(H).
15 45 C.F.R. § 165.524; 42 U.S.C. § 1795(e).
16 42 U.S.C. § 17935(c).
17 45 C.F.R. § 164.522; 42 U.S.C. § 17935(a).
18 See 45 C.F.R. § 164.502(b); 42 U.S.C. § 17935(b).
19 See 45 C.F.R. § 164.502(b); 42 U.S.C. § 17935(b).
OHIET Revised Strategic Plan Page 46
information for treatment, payment, health care operations and public health reporting
required by state and federal law.
Data Quality and Integrity:
Pursuant to OHIET's enabling legislation,20 OHIET trust agreements will make exchange
participants responsible for ensuring accuracy and integrity of data utilized for HIE.
Safeguards:
OHIET trust agreements will require exchange participants to comply with the Security
Rule21 provisions in order to achieve administrative, technical and physical safeguards for
accessing, maintaining and transmitting protected health information.
Further, OHIET will consider recommending a common set of procedures and
mechanisms to verify the credentials and authenticate the identity of persons requesting
and accessing information for exchange. OHIET will also consider recommending
standard privacy and security training guidelines for review and use by exchange
participants.
Accountability:
As further discussed in Section 1.5.5.3, through the express application of the Privacy and
Security Rules, along with other applicable state and federal privacy laws, OHIET trust
agreements will clearly signal exchange participants must comply with such requirements
and bear responsibility for instances of breach or other non‐compliance. In addition, the
standard procedures and training guidelines referenced immediately above could serve as
another resource toward ensuring exchange participants implement appropriate
accountability measures on an institutional level.
1.5.5.2. State Laws
OHIET anticipates working in conjunction with OKHISPC and engaging in ongoing efforts
to identify and analyze potential changes to state privacy laws to better serve HIE, both
within Oklahoma and with other states.
An Oklahoma statute subject to present discussion and analysis concerning potential
amendment requires a disclosure statement to accompany an authorization releasing
records containing reportable communicable or non‐communicable disease
information.22 The statute requires the statement to appear in bold‐faced type and
inform the individual authorizing release of the potential for inclusion of such information
in the disclosure. Stakeholders from Oklahoma's health care community and OKHISPC
have expressed concern that the detailed requirements of this statute present a barrier to
exchange.
20 See generally 63 O.S. § 1‐132(F).
21 45 C.F.R. §§ 145.302‐145.318.
22 See 63 O.S. § 1‐502.2.
OHIET Revised Strategic Plan Page 47
At the time of drafting, however, OHIET does not have any specific plans or proposals to
modify this or other state laws. Likewise, although OHIET has not yet entered into
discussions or negotiations with other states concerning HIE, OHIET will monitor HIE
efforts of other states and pursue communications with other states where doing so
could work to further inter‐state coordination and secure exchange of health information.
1.5.5.3. Policies and Procedures
OHIET anticipates utilizing the trust agreements discussed under 1.5.5.4 below as the
primary means of achieving adherence to uniform practices and procedures.
1.5.5.4. Trust Agreements
As noted throughout, OHIET trust agreements with exchange participants will serve as the
contractual mechanism OHIET will use to achieve uniform adoption of and compliance
with the consent model for exchange; the privacy and security requirements under which
exchange must occur; and the penalty provisions for acts of breach or non‐compliance
with federal or state law.
1.5.5.5. Oversight of Information Exchange and Enforcement
OHIET trust agreements will expressly inform exchange participants that oversight
authority and enforcement power for breaches and/or other acts of non‐compliance with
state and federal law rests with the government or regulatory agency charged with such
power. The standard policies, procedures, and training materials OHIET anticipates
recommending will further serve as best practices to mitigate the probability of breaches
or other misuse of information. The trust agreements will require exchange participants,
and empower OHIET, to provide notice of breaches and/or acts of non‐compliance to
appropriate government or regulatory officials where applicable law mandates such
action. Finally, the trust agreements will provide for termination of a participant's
agreement as a penalty in certain enumerated circumstances involving breach or non‐compliance
with federal or state law.
End of Oklahoma State Health Information Exchange Cooperative Agreement Program
Revised Strategic Plan
OHIET Revised Strategic Plan Page 48
Appendices
Project Month 1 2 3 4 5 6 7 8 9 101112131415161718192021222324252627282930313233343536373839404142434445464748495051
Year
Calendar Month N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J
State Trust developed
State Coordinator for HIT selected
Strategic Plan completed
Operational Plan completed
Strategic and Operational Plan approval
Evauate other certification processes
Identify elements of certification
Seek existing and planned HIO input into
certification requirements
Finalize certification process requirements
Begin certifying HIOs
Broadband program designed
Broadband program implemented
MU Incentives (Medicaid, Medicare)
inplace
Community HIO Planning Program
Designed
Community HIO Planning Program in place
HIE Voucher program designed
HIE Voucher program in place
eRX Pharmacy assistance program designed
eRx Pharmacy assistance program in place
Shared Services evaluation
Identification and prioritization of desired
shared services
Purchasing phase for shared services
Implementation of shared services
Consider Policy needs
Prioritize policy needs
Establish legislative agenda
Privacy and Security framework
Facilitate connections between HIOs and
border health systems and HIOs
Manage communications with ONC and
CMS
Strategy for interaction with Health
Benefits Exchange project
Strategy for facilitating interactions
between state agencies and HIOs
Coordination Policy Shared Services Incentive programs Certification Process
2013 2014
Planning Phase
2009 2010 2011 2012
3/31/2010 OKLAHOMA HEALTH INFORMATION TECHNOLOGY COORDINATOR 1
STATE OF OKLAHOMA
Job Description
Job Title: Oklahoma Health Information Technology Coordinator
Agency: Oklahoma Health Information Exchange Trust (“OHEIT”)
Reports To: State of Oklahoma Governor
Date Completed: March 31, 2010
Salary Range: TBD (depending upon experience)
PART I: DESCRIPTION OF POSITION
Position Purpose:
This position exists to provide leadership, direction, management and coordination of
healthcare information technology strategy for the State of Oklahoma which will include the
implementation of federal and state requirements for healthcare information technology (HIT)
and health information exchange (HIE).
This individual will work cooperatively with multiple stakeholders including health care
providers, health plans, health profession schools, consumers, technology vendors, public
health agencies, and health care purchasers to identify existing resources, needs,
commonalities of interest, project priority, and to develop a plan which prescribes the needed
activities to facilitate and expand the electronic movement and use of health information
among organizations consistent with the both state‐ and federal‐ health information
technology strategic plans.
Principal Activities: The principal activities and responsibilities include the following:
• Provide health informatics leadership, vision, and direction to the HIT office in collaboration
with the Oklahoma State Health Information Exchange Governance Committee.
• Provide expertise, including research and analysis required to establish and maintain a
strategy for implementing health information exchange in Oklahoma
• Identify new grant opportunities; serve as principle investigator (PI) as needed for grants
and direct the preparation of grant applications for funding for planning and implementing
HIT/HIE in Oklahoma.
• Review grant proposals to evaluate informatics components for issues relating to readiness,
collaboration, interoperability and certification.
• Assist HIT projects with conducting studies of existing and proposed information systems
and their impacts.
• Collect and analyze data on statewide HIT systems.
• Prepare written and oral reports, manuscripts and other communications summarizing the
findings of analyses and studies and disseminate the results.
• Present data, study findings and recommendations to the Governance Board, Advisory
Board, state agencies, legislators and other partners/stakeholders as needed to support the
statewide HIT/HIE system decision‐making process.
• Act as the State lead for HIT/HIE and participate in state, regional and national
health/scientific meetings focused on HIT/HIE.
3/31/2010 OKLAHOMA HEALTH INFORMATION TECHNOLOGY COORDINATOR 2
• Act as the designated Oklahoma representative at meetings related to HIE and associated
grants
• As needed, serve as an interface between the partners/stakeholders and the OHEIT staff on
identifying and addressing informatics issues.
• Coordinate statewide activities related to the implementation of HIT/HIE in Oklahoma in
order to improve the efficiency and effectiveness of health data collection, analysis and use
to improve the health of individuals and their communities.
• Provide direction in the development of the state HIT/HIE strategic plan.
• Coordinate resources and activities to assist with readiness assessments of public and
private health care entities to implement electronic information systems that meet federal
and state requirements and fit within the state HIE plan.
• Solicit input from relevant public and private partners/stakeholders, including consumers,
about the needs and barriers to implementing HIE in Oklahoma including barriers to
interoperability and ways to utilize opportunities and reduce barriers.
• Foster pilot projects and coordinate HIE‐related activities in collaboration with public and
private healthcare providers and health plans.
• Collaborate with federal standards and policy committees to develop common data
reporting formats and methods of transmission within Oklahoma and across state borders
for all pertinent health data.
• Maintain relationships with public and private partners/stakeholders for the purpose of
insuring coordination of all electronic health information systems planning, development,
implementation and interoperability.
• Provide training and information on ONC, NHIN administrative and technical requirements
for system interoperability and secure data exchange using the Web and other
communication methods.
• Perform other duties in support of the statewide HIT activities.
• Represent Oklahoma on national HIE/HIT issues and activities.
Supervisory Responsibilities: This position has supervisory responsibilities.
PART II: KNOWLEDGE AND BACKGROUND REQUIREMENTS
Qualifications:
This position requires a strong leader possessing excellent health informatics skills and strong
experience with information systems and information technology. The work of this position
requires expert knowledge of healthcare processes and systems both private and public,
program management, technological planning, organizational behavior, public policy
development and analytical evaluation and research skills. It requires the incumbent to develop
a strong working knowledge of the statewide private sector healthcare infrastructure;
information technology, medical informatics, legislative processes and operation of state
agencies.
Preference: Preference will be given to applicants with the following qualifications:
• An individual with an advanced clinical degree including nursing, medicine, dentistry or
pharmacy.
• An individual with clinical practice experience.
3/31/2010 OKLAHOMA HEALTH INFORMATION TECHNOLOGY COORDINATOR 3
• Masters or higher degree.
• Significant expertise and knowledge in HIT/HIE, particularly related to improving clinical
quality.
• Significant knowledge and experience in HIT/HIE public policy.
• Recognized leadership skills and experience in managing, creating or developing health
information technology.
• Extensive knowledge of information management principles, information technology
strategies and trends, and systems oversight abilities.
Qualified candidates will possess the following:
Education: Post baccalaureate degree from an accredited college or university with additional
training in business administration, public administration, finance, management information
systems, public health, health care management, or medical informatics.
Experience: Seven (7) years of pertinent work experience within the healthcare and/or public
health or industry. Three (3) years of program or project management experience which
include:
• Analyzing business processes and outcomes
• Financial reporting
• Planning, developing, and implementing information technology systems
• Managing large projects
• Writing and administrating grants
• Facilitating meetings Researching, interpreting and explaining technical information such as
laws, regulations and requirements.
Language Skills: Ability to read, analyze, and interpret technical documents, general business
periodicals, professional journals, technical procedures, or governmental regulations. Ability to
write reports, business correspondence, and procedure manuals. Ability to effectively present
information and respond to questions from stakeholders.
Mathematical Skills: Ability to work with mathematical concepts such as probability and
statistical inference with the ability to apply concepts to practical situations.
Reasoning Ability: Ability to solve practical problems and deal with a variety of concrete
variables in situations where only limited standardization exists.
Computer Literacy: Knowledge of health information technology concepts, including hardware,
software, networking, and associated costs and budgeting. Must have significant knowledge of
healthcare data standards (vocabularies, messaging, and security) and experience in
communicating these complex topics to learners and listeners at all levels.
Physical Demands/Work Environment: Reasonable accommodations may be made to enable
individuals with disabilities to perform the essential functions.
To: Advisory Board Member Organization
RE: Appointment of Personnel to Serve with the Oklahoma Health Information
Exchange Trust Advisory Board
Dear :
Recently passed into Oklahoma Legislation by Senate Bill 1373 was the establishment of a
public trust, the Oklahoma Health Information Exchange Trust (OHIET). The purpose of
OHIET is to ensure complete coverage of the state by health information exchanges (HIEs)
and transmission of electronic health data both intra‐ and interstate thereby raising the
overall quality of health of the population while making access more effective and
affordable.
Your organization has already made significant contribution to this (the Oklahoma State
Health Information Exchange Cooperative Agreement Program) and other areas of
HIT/HIE. Because of your commitment and leadership, we have included your
organization as a founding member of OHIET’s Advisory Board.
Request:
The Board of Trustees of OHIET requests that you nominate one individual to serve as your
representative. This individual should be a leader in your organization; they should
represent a consensus opinion of your organization; they should bring a deep level of
understanding of your organization and the constituencies you serve; they should be
willing to collaborate with a diverse set of views and devise creative paths and solutions;
they should be critical thinkers and have the ability to understand and eliminate bias.
Depending upon the role your representative takes, the time commitment from him/her
will range from one to four hours per week. We ask that representatives serve for a
minimum term of one year.
We very much appreciate your generosity in allowing this valuable employee to work with
us. We believe, with the assistance of organizations like yours, we will improve the overall
quality of care for the citizens of Oklahoma.
Once you have selected your representative, please send notification to this office,
_____________. We look forward to learning your member individual by October 15, 2010.
Thank you once again the effort you and your organization put toward these endeavors.
Signed by Trustees
Follows: more information about the position, Advisory Board and OHIET.
To: Advisory Board Member Organization
Re: Appointment of Personnel to Serve with the Oklahoma Health Information Exchange Trust Advisory Board
2/8
Position Purpose:
To represent the views and desires of your organization, to collaborate with several other
concerned constituents, and to add leadership and expertise to the Oklahoma Health
Information Exchange Trust (OHIET) and towards its intentions to meet stated goals. To
provide opinion and advice to the Board of Trustees; to work on task forces at a domain‐specific
level in order to make learned recommendations to the Board; to perform discrete
tasks as might be necessary.